Blood pressure patterns in pregnant patients on oral ketanserin
Background. Ketanserin, a selective serotonin-2 receptor antagonist, decreases systolic blood pressure (SBP) and diastolic blood pressure (DBP) in non-pregnant patients with hypertension, but not in normotensive subjects. Its effect on longitudinal blood pressure (BP) patterns in pregnant women has not been documented. Objectives. To assess how ketanserin, given orally, influences maternal BP during pregnancy. Design. A double-blind randomised controlled trial where patients with DBP ≥ 80 mmHg between 12 and 20 weeks' gestation received either ketanserin or placebo. Setting. Tygerberg Hospital, a tertiary referral unit in the Western Cape. Subjects. One hundred and two patients who received their study drug for at least 140 days during pregnancy. Patients requiring additional antihypertensive medication were excluded from the analysis. Outcome measures. Changes in SBP and DBP in relation to gestational age and days since entering the study. Results. The mean DBP over the total period was significantly lower in the ketanserin group (77 ± 8.7 mmHg v. 80.8 ± 9.1 mmHg). The decline in DBP was 9.2 mmHg in the ketanserin group and 5.3 mmHg in the placebo group. These differences were detected from within 7 days of therapy and persisted for most of the pregnancy. The mean SBP did not differ at any stage, although the mean fall in SBP was significantly greater in the ketanserin group (8.6 ± 16.7 v. 4.1 ± 17.1 mmHg). Conclusions. Ketanserin decreased DBP during pregnancy significantly more than placebo.