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Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Antihypertensives are generally not indicated for the treatment of preeclampsia-associated hypertension, except in severe preeclampsia. In the event of severe, acute hypertension (i.e., diastolic blood pressures greater than 110 mmHg), intravenous hydralazine in 5–10 mg doses will usually be effective. This dose can be increased and repeated every 15–20 min, as necessary. The treatment goal of medical therapy is to achieve a diastolic blood pressure less than 110 mmHg, and in the range of 90–100 mmHg. Caution must be exercised at the lower range to ensure adequate placental perfusion. Labetalol (10 mg IV) may also be given every 10 min. Higher doses (up to a total dose of 300 mg) may be necessary in some women to control hypertension.
Hypertension
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Labetalol is a beta-blocker that also has some alpha-1-blocking effects. It causes vasodilation without reflex tachycardia. Labetalol is given as a constant infusion or as regular bolus doses, and the boluses do not cause significant hypotension. Other uses include during pregnancy, after MI, and for intracranial disorders that need control of BP. Constant infusion and boluses are titrated upward to their maximum dosages. There are only slight adverse effects. However, since labetalol has beta-blocking effects, it is not used for asthmatic patients in hypertensive emergencies. If nitroglycerin is given at the same time, low doses of labetalol are used for left ventricular failure.
Hypertensive Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
On the basis of limited trial data, labetalol and nifedipine are the current antihypertensive drugs most used by experts. Labetalol dosing can start at 100 mg twice a day, with a maximum dose of 2400 mg a day. Nifedipine is started at 10 mg twice a day, or 30 mg XL once a day, with a maximum dose of 120 mg/day. Angiotensin-converting enzyme (ACE) inhibitors are contraindicated in pregnancy.
Blood pressure medication use and postpartum hospital readmission among preeclampsia patients
Published in Hypertension in Pregnancy, 2023
Timothy Gesner, Joshua Fogel, Lennox Bryson
Demographic variables were age, race (white, Hispanic, black, and other), and body mass index (kg/m2). Pregnancy related variables were gravida and parity. Past medical history consisted of pregestational diabetes and gestational diabetes. Preeclampsia history from a previous pregnancy and current pregnancy preeclampsia with severe features as defined by ACOG (1) were recorded. Systolic (mm Hg) and diastolic (mm Hg) blood pressure were from blood pressure taken on the day of discharge from the hospital. Blood pressure medication use was measured as no versus yes. The medications studied were oral labetalol, a beta blocker, and oral extended release nifedipine, a calcium channel blocker. Each medication was also a priori before analyses divided into a high-dose or low-dose category based upon clinical experience for considering dosages. Low dose for labetalol was any combined daily dose less than 599 mg (daily dose totals included 200, 300, and 400 mg), while high dose was any combined daily dose of 600 mg or greater (daily dose totals included 600, 800, 900, 1200, and 1,500 mg). Low dose for nifedipine were those that received 30 mg. High dose for nifedipine were those that received any combined daily dose of 60, 90, or 120 mg. The outcome variable of readmission to hospital within 6 weeks was measured as no versus yes.
Management of hypertensive emergencies: a practical approach
Published in Blood Pressure, 2021
Gian Paolo Rossi, Giacomo Rossitto, Chiarastella Maifredini, Agata Barchitta, Andrea Bettella, Raffaele Latella, Luisa Ruzza, Beatrice Sabini, Teresa M. Seccia
As a general principle, the choice of the drug to use in HEs patients is defined by the type of organ damage and the presence of contraindications to specific drug(s) or a class of agents (Table 1). In our experience labetalol was proved to be an effective all-round agent, well tolerated and with few contraindications. When given intravenously, it has alpha-blocking activity, which is useful in most HEs, including patients with PPGL. The onset of its antihypertensive effect occurs within 2–5 min and peaks over 5–15 min, which provides a good time window for titrating its rate of i.v. administration. A 20 mg priming i.v. bolus is usually followed by a continuous infusion, the rate of which can be up- or down-titrated to reach and maintain the desired BP target values. In the patients with hypertensive encephalopathy or stroke, labetalol should be preferred to nitrates, as nitroglycerine and nitroprusside, because it leaves the cerebral blood flow unaffected and does not increase intracranial pressure [47].
Management of hypertension in pregnancy: a descriptive report of two clinic practices
Published in Hypertension in Pregnancy, 2020
Sarah M. Westberg, Chrystian Pereira, Rebecca Rosdahl, Annette Do, Jean Y. Moon, Tanya Melnik
Of the 60 patients with elevated blood pressure findings in the course of their prenatal care, 12 (20%) patients were taking an antihypertensive agent before the pregnancy. There were six cases where previously antihypertensive-naive patients were started on antihypertensive treatment. Among those patients already taking antihypertensives, two medication regimens were changed in the course of prenatal care. In one case, lisinopril was changed to labetalol. In the second case, the combination of amlodipine plus hydrochlorothiazide was changed to methyldopa. In total, 18 (30%) of the 60 pregnant patients were treated with an antihypertensive agent during pregnancy, with most being treated with labetalol or methyldopa.