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Meta-Analysis
. 2025 Jul 13;13(3):91.
doi: 10.3390/medsci13030091.

Efficacy and Safety of Nifedipine Compared to Intravenous Hydralazine for Severe Hypertensive Disorders in Pregnancy: A Systematic Review and Meta-Analysis of Randmomized Controlled Trials

Vaisnavy Govindasamy  1 , Mohammed Amer Kamel  2 , Gabriele Volucke  3 , Aashir Javed  4 , Upayan Palchaudhuri  5 , Sayed Irfan Kazi  6 , Ahmad Albanna  7 , Mays Akileh  7   8 , Rohit Mukherjee  9 , Rabia Nusrat  10 , Tayyaba Qaiser  11 , Eman Ibrahim Elzain Hassan  12 , Muhammad Muneeb Azhar  13 , Tallal Mushtaq Hashmi  14 , Mushood Ahmed  14 , Ali Hasan  15 , Raheel Ahmed  15
Affiliations
Meta-Analysis

Efficacy and Safety of Nifedipine Compared to Intravenous Hydralazine for Severe Hypertensive Disorders in Pregnancy: A Systematic Review and Meta-Analysis of Randmomized Controlled Trials

Vaisnavy Govindasamy et al. Med Sci (Basel). .

Abstract

Background: Severe maternal hypertension is linked to adverse perinatal outcomes. Both nifedipine and hydralazine are commonly used antihypertensive agents in this setting. Methods: A comprehensive literature search was conducted in PubMed, Cochrane Library, and EMBASE from inception to April 2024 to identify randomized controlled trials comparing oral or sublingual nifedipine with intravenous hydralazine for the management of severe hypertension, with or without preeclampsia/eclampsia. A random-effects meta-analysis was performed using RevMan. Results: Seven randomized controlled trials were included. The pooled analysis demonstrated no significant difference between the two agents regarding time to achieve optimal blood pressure control (MD = -1.08 min, 95% CI = -6.66 to 4.49), caesarean delivery (OR = 0.62, 95% CI = 0.38 to 1.03), neonatal birth weight (MD = 57.65 g, 95% CI = -209.09 to -324.40), NICU admissions (OR = 0.90, 95% CI = 0.41 to 1.98), and 5-min APGAR scores (MD = 0.1, 95% CI = -0.20 to 0.39). However, patients receiving nifedipine had significantly lower odds of experiencing medication-related adverse events (OR = 0.62, 95% CI = 0.40 to 0.97). Conclusions: Nifedipine and intravenous hydralazine showed comparable efficacy in achieving optimal blood pressure control and similar maternal and neonatal outcomes. However, nifedipine was associated with significantly fewer maternal adverse effects, indicating superior tolerability.

Keywords: gestational hypertension; hypertension; preeclampsia.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart depicting the screening and study selection process.
Figure 2
Figure 2
Forest plot for (A) Time required for optimal BP control, (B) Caesarean section, (C) Medication-related adverse events. Forest plot showing odds ratios (blue squares) and 95% confidence intervals (horizontal lines) for individual studies comparing Nifedipine and Hydralazine. The black diamond represents the overall pooled effect using a Mantel-Haenszel random-effects model, with its width indicating the 95% CI.
Figure 3
Figure 3
Forest plot for (A) Neonatal birth weight, (B) NICU admissions, (C) 5-min. Forest plot showing odds ratios (blue squares) and 95% confidence intervals (horizontal lines) for individual studies comparing Nifedipine and Hydralazine. The black diamond represents the overall pooled effect using a Mantel-Haenszel random-effects model, with its width indicating the 95% CI.
See this image and copyright information in PMC

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