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Randomised controlled trial of ketanserin and aspirin in prevention of pre-eclampsia

dc.contributor.authorSteyn D.W.
dc.contributor.authorOdendaal H.J.
dc.date.accessioned2011-05-15T16:17:18Z
dc.date.available2011-05-15T16:17:18Z
dc.date.issued1997
dc.identifier.citationLancet
dc.identifier.citation350
dc.identifier.citation9087
dc.identifier.issn01406736
dc.identifier.other10.1016/S0140-6736(97)06408-8
dc.identifier.urihttp://hdl.handle.net/10019.1/14159
dc.description.abstractBackground. Pre-eclampsia is associated with extensive endothelial-cell damage and platelet activation, resulting in lower production of vasodilator prostaglandins and increased release of the vasoconstrictors thromboxane A2 and serotonin. Damage to endothelial-cell serotonin-1 receptors leaves vasoconstriction and platelet aggregation mediated by serotonin-2 receptors unopposed. We investigated the role of ketanserin, a selective serotonin-2-receptor antagonist, in lowering the rate of pre-eclampsia among pregnant women with mild to moderate hypertension. Methods. We recruited 138 pregnant women into a double-blind, randomised, placebo-controlled trial. They had diastolic blood pressure persistently more than 80 mmHg before 20 weeks' gestation. 69 women received ketanserin and 69 received placebo. Both groups also received aspirin. Patients were initially given two tablets daily, increased to four tablets daily in diastolic blood pressure was more than 90 mmHg. Primary outcomes were the development of pre-eclampsia and severe hypertension, and perinatal mortality. Findings. There were significantly fewer cases of preeclampsia (two vs 13; relative risk 0.15 [95% CI 0.04-0.66], p = 0.006) and severe hypertension (six vs 17; p = 0.02) in the ketanserin than in the placebo group. There was also a trend towards less perinatal mortality (one vs six deaths) but this was not significant (p = 0.28). Rates of abruptio placentae and pre-eclampsia before 34 weeks' gestation were lower in the ketanserin group, and mean birthweight was significantly higher. Interpretation. We found an association between the addition of ketanserin to aspirin and a decrease in the number of cases of pre-eclampsia and severe hypertension, as well as improved pregnancy outcome among patients with mild to moderate midtrimester hypertension.
dc.subjectacetylsalicylic acid
dc.subjectketanserin
dc.subjectserotonin
dc.subjectserotonin 2 receptor
dc.subjectthromboxane a2
dc.subjectadult
dc.subjectarticle
dc.subjectbirth weight
dc.subjectclinical trial
dc.subjectcontrolled study
dc.subjectdiastolic blood pressure
dc.subjectfemale
dc.subjecthuman
dc.subjectmajor clinical study
dc.subjectmaternal hypertension
dc.subjectoral drug administration
dc.subjectoutcomes research
dc.subjectperinatal mortality
dc.subjectpreeclampsia
dc.subjectpregnancy
dc.subjectpriority journal
dc.subjectrandomized controlled trial
dc.subjecttreatment outcome
dc.subjectAdult
dc.subjectAntihypertensive Agents
dc.subjectAspirin
dc.subjectDouble-Blind Method
dc.subjectDrug Therapy, Combination
dc.subjectFemale
dc.subjectHumans
dc.subjectHypertension
dc.subjectKetanserin
dc.subjectMiddle Aged
dc.subjectPlatelet Aggregation Inhibitors
dc.subjectPre-Eclampsia
dc.subjectPregnancy
dc.subjectPregnancy Complications, Cardiovascular
dc.subjectRisk Factors
dc.subjectSerotonin Antagonists
dc.titleRandomised controlled trial of ketanserin and aspirin in prevention of pre-eclampsia
dc.typeArticle
dc.description.versionArticle


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