Which Antihypertensive Drug for Hypertension in Pregnancy? Oxprenolol appears likely to provide fetal benefit

An open trial involving 183 hypertensive pregnant women compared the effects of oxprenolol and methyldopa on maternal BP and on the fetus. 100 patients were primagravidas. Patients randomly received oxprenolol (40-640 mg/day) or methyldopa (250-3000 mgjday) at doses titrated to achieve a sitting diastolic BP of ~ BOmm Hg. If adequate BP control was not achieved, titrated doses of hydralazine (12.5-300 mg/day; n = 64) and then the al ternate starling drug (n = 12) were also given.

There were no signif icant differences between the groups in the control of BP, duration of gestation or the indications for delivery. The mean birthweighl of the neonates was significantly higher in women treated with oxprenolol than in those treated with methyldopa. However, there were no significant differences between the oxprenolol and methyldopa groups in the birthweights of babies born to women requiring only 1 antihypertensive drug or in women treated for 8-12 weeks. Babies born to primagravidas 'were smaller than those born to multiparous women, and girls were smaller than boys. 34 babies were admitted to intensive care but there were no differences between groups. One baby died during pregnancy in the oxprenolol group and 4 neonates died in the methyldopa group. The authors concluded that' ___ for short term treatment there is potential fetal benefit from treatment with oXPfenolol'. Further, 'as hypertenston in pregnancy (whatever its underlying cause) may pursue an accelerated course, and it is uncertain in advance in which patients this is likely to occur, initial treatment with oxprenolol seem most reasonable. This would be our recommendation, provided that there is no maternal contraindication to the administration of jJ blocking agents', Gallef}'. E.D.M .. Ross. MR. and Gyof}'. A.Z. Btjlish Medical Journal 291: 563·566 (31 Aug 1985)

0156.2703/85/0914-C009/0$01.00/0 (l AOIS PIIISI INPHARMA~ 14 Sap 1985 9