viewpoints USING ~-BLOCKERS IN PREGNANCY-ASSOCIATED HYPERTENSION

Replacement of methyldopa will need demonstration of advantage and safety American physicians have been reluctant to treat hypertension with {3-blockers during pregnancy, but Dr Peter Rubin has completed a study using atenolol vs placebo, indicating that there are advantages to /3-blocker treatment. The trial involved 120 pregnant women with BPs of 140-170/90-11 Omm Hg in their last trimester. Atenolol 100-200 mgjday effectively lowered BP and improved the outcome of pregnancy. Proteinuria (an indicator of fetal distress) developed in all placebo patients vs 4 atenolol patients. Respiratory distress was seen in infants of 3 controls vs no treated patient, hypoglycaemia in infants of 5 controls vs 2 treated patients and intrauterine death occurred in 2 patients in the control group and in 1 atenolql patient. Bradycardia, however, was more common in the infants of those on atenolol (22) than those on placebo (6) but lasted less than 10 min. Despite these findings, fears of {3-blockers decreasing placental blood flow and hence retarding intrauterine growth concerns many doctors. Treatment of hypertension in pregnancy, then, should probably include methyldopa with hydralazine or a diuretic. Another trial in Australia compared oxprenolol hydrochloride with methyldopa for this indication and found birthweights were higher on oxprenolol. However, larger trials will be needed to confirm the safety and advantage over methyldopa. Fuerst, M.: Journal of the American Medical Association 248: 516 (6 Aug !982)

2 INPHARMA 25 Sep 1982 0156-2703/82/0925-0002/0$01.00/0 "' ADIS Press