Dihydralazine or ketanserin for severe hypertension in pregnancy? Preliminary results
Objective: To compare the efficacy and safety of intravenous dihydralazine with ketanserin in the management of severe hypertension in the third trimester. Study design: A double blind randomised controlled trial, comparing 5 mg dihydralazine with 10 mg ketanserin after an intravenous infusion of 500 ml of a crystalloid solution. Medication was repeated every 20 min till the therapeutic goal of 90 mm Hg was reached, to a maximum of 4 dosages. Main outcome measures were treatment failures and emergency deliveries for fetal distress. Results: The therapeutic goal was met more often in patients receiving dihydralazine (36/38 compared to 27/42; P<0.01). The need for delivery for fetal distress did not differ (3 after dihydralazine, 1 after ketanserin, P=0.29). No therapy related perinatal loss occurred, but one mother with an undiagnosed phaechromocytoma died 24 h after receiving dihydralazine. Conclusion: Ketanserin in this dosage is less effective to lower diastolic blood pressure. The place of a fluid load prior to dihydralazine needs to be further investigated, as fetal heart rate decelerations were less common-than previously reported.