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. 2000;2003(4):CD002863.
doi: 10.1002/14651858.CD002863.

Oral beta-blockers for mild to moderate hypertension during pregnancy

L A Magee  1 , L Duley
Affiliations

Oral beta-blockers for mild to moderate hypertension during pregnancy

L A Magee et al. Cochrane Database Syst Rev. 2000.

Update in

Abstract

Background: Hypertension is a common complication of pregnancy. Antihypertensive drugs are widely used in the belief these will improve outcome for both the woman (such as decreasing the risk of stroke or eclampsia) and her baby (such as decreasing the risk of preterm birth and its complications). Beta-blockers are a popular choice of antihypertensive agent during pregnancy; other choices include methyldopa and calcium channel blockers.

Objectives: The aim of this review is to assess whether oral beta-blockers are overall better than placebo, or no beta-blocker, for women with mild-moderate hypertension during pregnancy, and to assess whether oral beta-blockers have any advantages over other antihypertensive agents for women with mild-moderate hypertension during pregnancy. Both maternal outcomes (e.g., the incidence of severe hypertension) and perinatal outcomes (e.g., mortality) were of interest.

Search strategy: Register of trials maintained by the Cochrane Pregnancy and Childbirth Group, MEDLINE 1966-97, bibliographies of retrieved papers, personal files. Date of last search: June 2000.

Selection criteria: Trials comparing beta-blockers with (i) placebo or no therapy, or (ii) other antihypertensive agents, for women with mild-moderate pregnancy hypertension (i.e., blood pressure under 170 mm Hg systolic, or 110 mm Hg diastolic).

Data collection and analysis: All data were extracted independently by two investigators, who were not blinded to outcome or other trial characteristics. Whenever possible, missing data were obtained by personal communication with authors. Discrepancies were resolved by discussion. The overview was divided into two comparisons: (i) beta-blockers versus placebo or no therapy, and (ii) beta-blockers versus other antihypertensives.

Main results: Twenty-seven trials, involving just under 2400 women, are included in this review. Fourteen trials (1516 women) compared beta-blockers with placebo/no beta blocker. Oral beta-blockers decrease the risk of severe hypertension (relative risk (RR) 0.37, 95% confidence interval (CI) 0.26-0.53) and the need for additional antihypertensive drugs (RR 0.44, 95% CI 0.31-0.62). There are insufficient data for any conclusions about the effect on perinatal mortality or preterm delivery. Beta-blockers seem to be associated with an increase in small for gestational age infants (RR 1.34, 95% CI 1.01-1.79). Maternal hospital admission may be decreased, neonatal bradycardia increased and respiratory distress syndrome decreased, but these outcomes are only reported in a very small proportion of trials. Eleven trials (787 women) compared beta-blockers with methyldopa. Beta-blockers appear to be no more effective and probably equally as safe (from maternal and perinatal perspectives) as methyldopa. Single small trials have compared beta-blockers with hydralazine and with nicardipine. It is unusual for women to change drugs due to side effects.

Reviewer's conclusions: The improvement in control of maternal blood pressure with use of beta-blockers would be worthwhile only if it were reflected in other more substantive benefits for the mother and/or baby, and none have yet been clearly demonstrated. The effect of beta-blockers on perinatal outcome is uncertain, given that the worrying trend to an increase in small for gestational age infants is partly dependent on one small outlying trial. Large, randomised controlled trials are needed to determine whether antihypertensive therapy in general (rather than beta-blocker therapy specifically) results in benefits that outweigh the risks for treatment of mild-moderate pregnancy hypertension. If so, then it would be appropriate to look at which antihypertensive is best. Beta-blockers would remain a candidate class of agents.

PubMed Disclaimer

Conflict of interest statement

Dr Magee has received a speaker's fee from Shire Inc, the manufacturer of labetalol.

Figures

1.1
1.1. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 1 Maternal death.
1.2
1.2. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 2 Eclampsia.
1.3
1.3. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 3 Severe hypertension.
1.4
1.4. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 4 Proteinuria at delivery.
1.5
1.5. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 5 Additional antihypertensive drugs.
1.6
1.6. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 6 Changed drugs due to maternal side effects.
1.7
1.7. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 7 Admission to hospital prior to delivery.
1.8
1.8. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 8 Placental abruption.
1.9
1.9. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 9 Caesarean section.
1.10
1.10. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 10 Perinatal mortality.
1.11
1.11. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 11 Preterm delivery.
1.12
1.12. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 12 Small‐for‐gestational‐age infants.
1.13
1.13. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 13 Admission to special care baby unit.
1.14
1.14. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 14 Neonatal jaundice.
1.15
1.15. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 15 Neonatal bradycardia.
1.16
1.16. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 16 Neonatal hypoglycaemia.
1.17
1.17. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 17 Neonatal hypothermia.
1.18
1.18. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 18 Apgar score less than 7 at 5 minutes.
1.19
1.19. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 19 Respiratory distress syndrome.
1.20
1.20. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 20 Cerebral palsy at 1 year.
1.21
1.21. Analysis
Comparison 1 Beta‐blocker versus placebo/no beta‐blocker, Outcome 21 IQ less than one standard deviation below mean.
2.1
2.1. Analysis
Comparison 2 Beta‐blocker versus other antihypertensive therapy, Outcome 1 Eclampsia.
2.2
2.2. Analysis
Comparison 2 Beta‐blocker versus other antihypertensive therapy, Outcome 2 Severe hypertension.
2.3
2.3. Analysis
Comparison 2 Beta‐blocker versus other antihypertensive therapy, Outcome 3 Proteinuria.
2.4
2.4. Analysis
Comparison 2 Beta‐blocker versus other antihypertensive therapy, Outcome 4 Additional antihypertensive drugs.
2.5
2.5. Analysis
Comparison 2 Beta‐blocker versus other antihypertensive therapy, Outcome 5 Changed drugs due to maternal side effects.
2.6
2.6. Analysis
Comparison 2 Beta‐blocker versus other antihypertensive therapy, Outcome 6 Admission to hospital prior to delivery.
2.7
2.7. Analysis
Comparison 2 Beta‐blocker versus other antihypertensive therapy, Outcome 7 Caesarean section.
2.8
2.8. Analysis
Comparison 2 Beta‐blocker versus other antihypertensive therapy, Outcome 8 Perinatal mortality.
2.9
2.9. Analysis
Comparison 2 Beta‐blocker versus other antihypertensive therapy, Outcome 9 Preterm delivery.
2.10
2.10. Analysis
Comparison 2 Beta‐blocker versus other antihypertensive therapy, Outcome 10 Small‐for‐gestational‐age infants.
2.11
2.11. Analysis
Comparison 2 Beta‐blocker versus other antihypertensive therapy, Outcome 11 Admission to special care baby unit.
2.12
2.12. Analysis
Comparison 2 Beta‐blocker versus other antihypertensive therapy, Outcome 12 Neonatal jaundice.
2.13
2.13. Analysis
Comparison 2 Beta‐blocker versus other antihypertensive therapy, Outcome 13 Neonatal bradycardia.
2.14
2.14. Analysis
Comparison 2 Beta‐blocker versus other antihypertensive therapy, Outcome 14 Neonatal hypotension.
2.15
2.15. Analysis
Comparison 2 Beta‐blocker versus other antihypertensive therapy, Outcome 15 Neonatal hypoglycaemia.
2.16
2.16. Analysis
Comparison 2 Beta‐blocker versus other antihypertensive therapy, Outcome 16 Apgar score less than 7 at 5 minutes.
2.17
2.17. Analysis
Comparison 2 Beta‐blocker versus other antihypertensive therapy, Outcome 17 Respiratory distress syndrome.
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Sweden 1985 {published data only}
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References to studies excluded from this review

Argentina 1986 {published data only}
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Canada 1988 {published data only}
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England 1986 {published data only}
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France 1988c {published data only}
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France 1988e {published data only}
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France 1989 {published data only}
    1. Mintz P, Ciraru‐Vigneron N, Ravina JH, Pruna A, Bonnin P, Beaufils M. Comparison of the effects of nifedipine and atenolol in the treatment of uncomplicated gestational hypertension [Comparaison des effets de la nifedipine et de l'atenolol dans le traitement de l'hypertension arterielle gravidique non compliquee]. Therapie 1989;44:461.
France 1990a {published data only}
    1. Ciraru‐Vigneron N, Pruna A, Mintz P, Bonnin P, Lefevre V, et al. Comparison of nifedipine and atenolol in treatment of moderate pregnancy hypertension.. Proceedings of the 7th World Congress of Hypertension in Pregnancy; 1990; Perugia, Italy, 1990:340. Perugia, 1990:340.
France 1990b {published data only}
    1. Bonnin Ph, Mintz Ph, Kedra AW, Pruna A, Ciraru‐Vigneron N, Savin E, et al. Effects of nifedipine and atenolol on the fetal‐maternal circulation in moderate hypertension in pregnancy [Effets de la nifedipine et de l'atenolol sur les circulations foeto:maternelles en cas d'hypertension arterielle gravidique moderee]. Therapie 1990;45:525.
France 1992 {published data only}
    1. Ciraru‐Vigneron N, Pruna A, Akposso K, Bonnin Ph, Kedra W, Mintaz Ph, et al. Comparison of the effects of nifedipine and atenolol in uncomplicated gestational hypertension [Comparaison des effects de la nifedipine et de l'atenolol dans le traitement de l'hypertension arterielle gravidique non compliquee]. Therapie 1992;47:221.
Hong Kong 1993 {published data only}
    1. Yuen FT, Mo YP, Yin LC, Terence L. A double‐blind randomised placebo controlled trial of labetalol in the treatment of mild pregnancy induced hypertension.. Proceedings of 2nd International Scientific Meeting of the Royal College of Obstetricians and Gynaecologists; 1993; Hong Kong, Singapore, 1993. Hong Kong, Singapore, 1993.
Ingemarsson 1991 {unpublished data only}
    1. Ingemarsson I. Trial to assess the effects of atenolol or pindolol in pregnancy on pregnancy‐induced hypertension. Personal communication February 1991.
Israel 1988 {published data only}
    1. Paran E, Maisner I, Holzberg G, Mazor M, Zmora E, Biale Y, et al. Beta‐blocker treatment of PIH correlated with uteroplacental blood flow measurement.. Proceedings of the 6th International Congress, International Society for the Study of Hypertension in Pregnancy; 1988 May 22‐26; Montreal, Quebec, Canada, 1988:109. Montreal, 1988:109.
Israel 1992b {published data only}
    1. Meizner I, Paran E, Katz M, Holcberg G, Insler V. Flow velocity analysis of umbilical and uterine artery flow in pre‐eclampsia treated with propranolol or pindolol. Journal of Clinical Ultrasound 1992;20:115‐9. - PubMed
Israel 1994 {published data only}
    1. Bar J, Hirsch M, Friedman S, Fuchs J, Ovadia J, Bott‐Kanner G. The effect of beta‐adrenergic blocker pindolol on platelet function in chronic hypertensive pregnancies.. Proceedings of the 9th International Congress, International Society for the Study of Hypertension in Pregnancy; 1994; Sydney, Australia, 1994:155. Sydney, 1994:155.
Italy 1986 {published data only}
    1. Martinelli P, Ferrara LA, Pasanisi F, Arpaia F, Paladini D, Mancini M, et al. Nifedipine and atenolol in the treatment of pregnancy associated hypertension.. Proceedings of the 5th International Congress for the International Society for the study of Hypertension in Pregnancy; 1986 7‐10 July; Nottingham, England, 1986:128. Nottingham, 1986:128.
Italy 1988 {published data only}
    1. Orlandi C, Marlettini MG, Cassani A, Crippa S. Antihypertensive therapy in pregnancy.. Proceedings of the 11th European Congress of Perinatal Medicine; 1988; Rome, Italy, 1988:271. Rome, 1988:271.
Italy 1990 {published data only}
    1. Marlettini MG, Crippa S, Morselli‐Labate AM, Contarini A, Orlandi C. Randomized comparison of calcium antagonists and beta‐blockers in the treatment of pregnancy‐induced hypertension. Current Therapeutic Research 1990;45:684‐94.
Kuwait 1995 {published data only}
    1. El‐Qarmalawi AM, Morsy AH, Al‐Fadly A, Obeid A, Hashem M. Labetalol vs methyldopa in the treatment of pregnancy‐induced hypertension. International Journal of Gynecology & Obstetrics 1995;49:125‐30. - PubMed
Lule 1992 {unpublished data only}
    1. Lule J. Aspirin and methyldopa for moderate hypertension in pregnancy. Personal communication June 6 1992.
N Ireland 1986 {published data only}
    1. Harper A, Murnaghan GA, Erskine L, Ritchie JK. Response of fetal umbilical artery time velocity waveforms to antihypertensive drugs.. Proceedings of the British Congress of Obstetrics and Gynaecology; 1986; UK, 1986:33. 1986:33.
N Ireland 1991 {published data only}
    1. Harper A, Murnaghan GA. Maternal and fetal haemodynamics in hypertensive pregnancies during maternal treatment with intravenous hydralazine or labetalol. British Journal of Obstetrics and Gynecology 1991;98:453‐9. - PubMed
Pello 1988 {unpublished data only}
    1. Pello L. Multicentre trial of treatment of hypertension in pregnancy. Personal communication October 18 1988.
Scotland 1983a {published data only}
    1. Lang GD, Lowe GDO, Walker JJ, Forbes CD, Calder AA. Increased blood viscosity in pre‐eclampsia: effect of treatment with labetolol. Thrombosis and Haemostasis 1983;50(1):156.
Singapore 1998 {published data only}
    1. Yin KH, Koh SC, Malcus P, SvenMontan S, Biswas A, Arulkumaran S. Preeclampsia: haemostatic status and the short‐term effects of methyldopa and isradipine therapy. Journal of Obstetrics and Gynaecology Research 1998;24:231‐8. - PubMed
Spain 1988 {published data only}
    1. Torres Pons PJ, Roca M, Codina C, Cobo E, Cararach V, Gonzalez‐Merlo J. Labetalol in the treatment of mild hypertension in pregnancy. A double blind controlled trial.. 6th International Congress, International Society for the Study of Hypertension in Pregnancy; 1988 May 22‐26; Montreal, Quebec, Canada, 1988:102. Montreal, 1988:102.
Sweden 1986a {unpublished data only}
    1. Wichman K. Metoprolol in the treatment of mild to moderate hypertension in pregnancy ‐ effects on the newborn baby. Personal communication November 19 1986.
Sweden 1986b {unpublished data only}
    1. Wichman K. Metoprolol in the treatment of mild to moderate hypertension in pregnancy ‐ two‐year follow‐up study of the infants. Personal communication November 19 1986.
Sweden 1990 {published data only}
    1. Montan S, Ingemarsson I, Marsal K, Sjoberg NO. Negative influence of atenolol compared with pindolol on fetal hemodynamics in pregnancies with hypertension ‐ a controlled study.. Proceedings of the 7th World Congress of Hypertension in Pregnancy; 1990; Perugia, Italy, 1990:192. Perugia, 1990:192.
Sweden 1992 {published data only}
    1. Montan S, Ingemarsson I, Marsal K, Sjoberg NO. Randomised controlled trial of atenolol and pindolol in human pregnancy: effects on fetal haemodynamics. BMJ 1992;304:946‐9. - PMC - PubMed
Sweden 1993b {published data only}
    1. Hjertberg R, Faxelius G, Belfrage P. Comparison of outcome of labetalol or hydralazine therapy during hypertension in pregnancy in very low birth weight infants. Acta Obstetricia et Gynecologica Scandinavica 1993;72:611‐5. - PubMed
USA 1981 {published data only}
    1. Welt SI, Dorminy JH, Jelovsek FR, Crenshaw MC, Gall SA. The effect of prophylactic management and therapeutics on hypertensive disease in pregnancy: preliminary studies. Obstetrics and Gynecology 1981;57:557‐65. - PubMed
USA 1987a {unpublished data only}
    1. Welt SI. The use of prophylactic antihypertensive therapy in chronic hypertension in pregnancy. Personal communication October 27 1987.
USA 1990b {unpublished data only}
    1. Weiner CP. Trial to evaluate oral hypotensive agents in early onset preeclampsia. Personal communication November 1990.
Wales 1991 {published data only}
    1. Blake S, MacDonald D. The prevention of the maternal manifestations of pre‐eclampsia by intensive antihypertensive treatment. British Journal of Obstetrics and Gynaecology 1991;98:244‐8. - PubMed

References to studies awaiting assessment

Alves 1998 {published data only}
    1. Alves EA. Estudo prospectivo comparativo da isradipina e atenolol no tratamento de gestantes hipertensas [Prospective, comparative study of isradipine and atenolol for the treatment of hypertensive pregnant women] [thesis]. Sao Paolo: University of Sao Paulo, 1998.
August 2005 {published data only}
    1. August P. Treatment targets for chronic hypertension in pregnancy. http://clinicaltrials.gov/ct2/show/record/NCT00194974 (accessed 3 June 2012) 2005.
Centeno 2007 {published data only}
    1. Centeno DMW, Urbina JCP, Las Salas M, Fuenmayor AJ. Effect of carvedilol in the treatment of hypertension in pregnant women. XLIV ERA‐EDTA Congress; 2007 June 21‐24; Barcelona, Spain. 2007:Poster no: FP078.
Darcie 2004 {published data only}
    1. Darcie S, Leone CR, Calil VMLT, Prescinotti EP, Kahhale S, Zugaib M. Glycemia in newborns of hypertensive mothers according to maternal treatment. Revista do Hospital das Clinicas 2004;59(5):244‐50. - PubMed
Freire 1988 {published data only}
    1. Freire FS, Franca LA, Callou MRA, Oliveira JEA, Filho JB. Comparative study with pindolol and methildopa in pregnant women with chronic hypertension. Jornal Brasileiro de Ginecologia 1988;98(3):157‐60.
Gallery 1984 {published data only}
    1. Gallery EDM, Gyory AZ. Antihypertensive therapy in pregnancy [abstract]. Kidney International 1984;26(2):232.
Gonzalez 1997 {published data only}
    1. Gonzalez JC, Andolcetti R. Labetalol vs alpha methyldopa in the treatment of hypertension in pregnancy [Labetalol vs alfa metildopa en el tratamiento de la hipertension arterial asociada con el embarazo]. Boletin Medico de Postgrado 1997;13(1):3‐8.
Hameed 2008 {published data only}
    1. Hameed AB. A comparison of compliance between clonidine patch and methyldopa for the treament of chronic hypertension in pregnancy. ClinicalTrials.gov (http://clinicaltrials.gov/) (accessed 20 February 2008). NCT00329511 2008.
Leone 2003 {published data only}
    1. Leone CR, Calil VMLT, Darcie S, Prescinotti EP, Kahhale S, Zugaib M. Growth of newborn of the mothers with hypertension during the first year of life: influence of therapeutics in pregnancy. Revista Paulista de Pediatria 2003;21(1):19‐26.
Lindeberg 1985 {published data only}
    1. Lindeberg S, Axelsson O, Lindberg BS, Lindmark G, Ludviksson K, Sandstrom B. Effect of metoprolol in combination with hydralazine on fetal heart rate patterns during hypertensive pregnancy and delivery. Clinical & Experimental Hypertension ‐ Part B, Hypertension in Pregnancy 1985;4(1):87‐94.
Osvaldo 2012 {published data only}
    1. Osvaldo A, Reyes T. Hydralazine vs. Labetalol for the management of hypertensive crisis in patients with hypertensive disorders of pregnancy. a randomized controlled trial. http://clinicaltrials.gov/ct2/show/record/NCT01538875 (accessed 3 July 2012).
Pandey 2011 {published data only}
    1. Pandey K, Gupta N, Gupta R, Gupta S. Comparing obstetric outcome using labetalol/methyldopa in pregnancy induced hypertension. 54th All India Congress of Obstetrics and Gynaecology; 2011 January 5‐9; Hyderabad, Andhra Pradesh, India. 2011:46.
Paran 1988 {published data only}
    1. Paran E, Baile Y, Holzberg G, Masor M, Zmora E, Insler V. Treatment of hypertension in pregnancy: different regime, different outcome. 6th International Congress of the International Society for the Study of Hypertension in Pregnancy; 1988 May 22‐26, Montreal, Quebec, Canada. 1988:105.
Rubin 1983 {published data only}
    1. Rubin PC, Butters L, Low RA, Clark DC, Reid JL. Atenolol in the management of hypertension during pregnancy. Drugs 1983;25:212‐4.
Voto 1985 {published data only}
    1. Voto LS, Lapidus AM, Neira J, Magulies M. Treatment of hypertension in pregnancy: atenolol versus alpha‐methyldopa [Tratamiento de la hipertension en el embarazo: atenolol versus alfa metildopa]. Obstetricia y Ginecologia Latino‐Americanas 1985;43(9‐10):335‐41.
Voto 1990 {published data only}
    1. Voto LS, Quiroga CA, Lapidus AM, Catuzzi P, Uranga IF, Margulies M. Effectiveness of antihypertensive drugs in the treatment of hypertension in pregnancy. Clinical and Experimental Hypertension ‐ Part B Hypertension in Pregnancy 1990;9(3):339‐48.
Warren 2004 {published data only}
    1. Warren J, Lacoursiere Y, Varner M, Silver R, Anthony J, Belfort M. First interim report on the labetalol versus magnesium sulfate for the prevention of eclampsia trial (LAMPET) [abstract]. Hypertension in Pregnancy 2004;23(Suppl 1):9.

Additional references

Abalos 2002
    1. Abalos E, Duley L, Steyn DW, Henderson‐Smart DJ. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy (Cochrane Review). The Cochrane Library 2002, Issue 1. - PubMed
Brown 2000
    1. Brown MA, Hague WM, Higgins J, Lowe S, McCowan L, Oats J, et al. The detection, investigation and management of hypertension in pregnancy: executive summary. Australian and New Zealand Journal of Obstetrics and Gynaecology 2000;40(2):133‐8. - PubMed
Collins 1989
    1. Collins R, Wallenburg HCS. Pharmacological prevention and treatment of hypertensive disorders in pregnancy. In: Chalmers I, Enkin M, Keirse MJNC editor(s). Effective Care in Pregnancy and Childbirth. Oxford: Oxford University Press, 1989:512‐33.
DH 1998
    1. Department of Health, Welsh Office, Scottish Home and Health Department, Department of Health and Social Security, Northern Ireland. Report on Confidential Inquiries into Maternal Deaths in the United Kingdom 1994‐96. London: HMSO, 1998.
Duley 1992
    1. Duley L. Maternal mortality and hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean. British Journal of Obstetrics and Gynaecology 1992;99:547‐53. - PubMed
Duley 2002
    1. Duley L, Henderson‐Smart DJ. Drugs for rapid treatment of very high blood pressure during pregnancy (Cochrane Review). The Cochrane Library 2002, Issue 1. - PubMed
Easterling 1999
    1. Easterling TR, Brateng D, Schmucker B, Brown Z, Millard SP. Prevention of preeclampsia: a randomized trial of atenolol in hyperdynamic patients before onset of hypertension. Obstetrics & Gynecology 1999;93:725‐33. - PubMed
Knight 2002
    1. Knight M, Duley L, Henderson‐Smart DJ, King JF. Antiplatelet agents for preventing and treating pre‐eclampsia (Cochrane Review). The Cochrane Library 2002, Issue 1. - PubMed
Laupacis 1988
    1. Laupacis A, Sackett DL, Roberts RS. As assessment of clinically useful measures of the consequences of treatment. New England Journal of Medicine 1988;318:1728‐33. - PubMed
Lydakis 1999
    1. Lydakis C, Lip GYH, Beevers M, Beevers DG. Atenolol and fetal growth in pregnancies complicated by hypertension. American Journal of Hypertension 1999;12:541‐7. - PubMed
NHB 2000
    1. National High Blood Pressure Education Program Working Group. Report on High Blood Pressure in Pregnancy. American Journal of Obstetrics and Gynecology 2000;183:S1‐22. - PubMed
Redman 1989
    1. Redman CWG. Hypertension in pregnancy. In: Turnbull AC, Chamberlain GVP editor(s). Textbook of obstetrics. London: Churchill Livingstone, 1989:515‐41.
Redman 1993
    1. Redman CW. Management of severe, early pre‐eclampsia: is conservative management justified?. European Journal of Obstetrics & Gynecology and Reproductive Biology 1993;51:175‐80. - PubMed
RevMan 2000 [Computer program]
    1. The Cochrane Collaboration. Review Manager (RevMan) [Computer program]. Version 4.1 for Windows. Oxford, England: The Cochrane Collaboration, 2000.
Rey 1997
    1. Rey E, LeLorier J, Burgess E, Lange IR, Leduc L. Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of hypertensive disorders in pregnancy. Canadian Medical Association Journal 1997;157:1245‐54. - PMC - PubMed
von Dadelszen 2000
    1. Dadelszen P, Ornstein MP, Bull SB, Logan AG, Koren G, Magee LA. Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta‐analysis. Lancet 2000;355:87‐92. - PubMed

References to other published versions of this review

CDSR 2003
    1. Magee LA, Duley L. Oral beta‐blockers for mild to moderate hypertension during pregnancy (Cochrane Review). The Cochrane Library 2003, Issue 2. - PubMed
Collins 1995a
    1. Collins R, Duley L. Beta‐blockers vs methyldopa in the treatment of pre‐eclampsia. [ revised 21 March 1994] In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C (eds.) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM]. The Cochrane Collaboration; Issue 2, Oxford: Update Software; 1995.
Collins 1995b
    1. Collins R, Duley L. Beta‐blockers in the treatment of pre‐eclampsia. [ revised 21 April 1994] In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C (eds.) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM]. The Cochrane Collaboration; Issue 2, Oxford: Update Software; 1995.

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