Management of hypertensive emergencies of pregnancy by hydralazine bolus injection vs continuous drip--a comparative study

Abstract

This prospective study was conducted at Dhaka Medical College and Hospital, Bangladesh. The objective was to identify the time required to control high blood pressure levels in obstetric patients by injection of hydralazine in a bolus intravenous dose vs continuous drip. Seventy-seven patients with eclampsia and hypertensive emergencies comprised the target population. Patients were managed either by hydralazine drip in normal saline (existing official protocol, n = 33) or hydralazine bolus injection (as experiment, n = 44) until diastolic blood pressure fell to 90-95 mmHg. Results were compared. Student's t-test was done for statistical significance, and a P value of <.05 was considered as significant. The groups were similar with respect to maternal age and their mean systolic and diastolic blood pressure at the time of enrollment. Patients who received bolus injection required less time to achieve the therapeutic goal (65.23 +/- 23.38 minutes) than continuous drip (186.36 +/- 79.77 minutes; P <.001). The experimental group also required significantly lower doses (6.68 +/- 1.66 mg) in comparison to that required by control group (20.07 +/- 11.38 mg; P <.001). There was no overshoot hypotension in either group. The data suggest that hydralazine bolus dose is equally safe and more effective than continuous drip in the management of hypertensive emergencies in pregnancy.