Management of Severe Hypertension in the Postpartum Period with Intravenous Hydralazine or Labetalol: A Randomized Clinical Trial

Objective: To compare the safety and efficacy of intravenous labetalol and intravenous hydralazine for acutely lowering blood pressure in the puerperium. Design: Randomized clinical trial. Setting: Critical care unit of gynecology and obstetrics department in the Complejo hospitalario “Dr. AAM” de la Caja de Seguro Social in Panama. Population: Eighty-two women with severe hypertension during the postpartum period. Methods: Patients were randomized to receive hydralazine (5 mg as a slow bolus dose given intravenously, and repeated every 20 minutes to a maximum of five doses) or labetalol (20 mg in an intravenous bolus dose followed by 40 mg if not effective within 20 minutes, followed by 80 mg every 20 minutes to a maximum dose of 300 mg). The primary endpoint was the successful lowering of blood pressure. Secondary endpoints were maternal complications and side-effects. Results: Forty-two women were enrolled in the hydralazine group and 40 in the labetalol group. Women were similar with respect to characteristics at randomization. No significant differences were observed for persistent severe hypertension or maternal side-effects. There was only one case of persistent severe hypertension in the labetalol group. There were no maternal deaths in any of the women studied. Conclusions: This randomized clinical trial shows that intravenous hydralazine and intravenous labetalol are effective and safe in the management of severe hypertension in the postpartum period.