Atenolol is worst antihypertensive agent for pregnant women, says study

Use of atenolol in pregnant women with chronic hypertension appears to significantly increase the risk for small-for-gestational-age infants, suggests a study.

In addition, severe hypertension incidence was “significantly lower when nifedipine and methyldopa were administered, although pre-eclampsia risk was similar among antihypertensive agents,” according to the investigators.

The following databases were systematically searched from inception to 15 December 2019: Medline, Scopus, Central, Web of Science, Clinicaltrials.gov, and Google Scholar. Randomized controlled trials (RCTs) and cohort studies were eligible if they reported the effects of antihypertensive agents on perinatal outcomes among women with chronic hypertension.

The investigators fitted a frequentist network meta-analytic random-effects model. They assessed the credibility of evidence by considering within-study bias, across-studies bias, indirectness, imprecision, heterogeneity, and incoherence. The main analysis was based on RCTs.

Twenty-two studies (14 RCTs and eight cohort), comprising 4,464 women, met the eligibility criteria. In the pooled analysis, no agent significantly influenced the incidence of pre-eclampsia. Compared with placebo, atenolol correlated with a significantly higher risk of small-for-gestational age (odds ratio [OR], 26.00, 95 percent confidence interval [CI], 2.61–259.29) and was classified as the worst treatment (p=0.98).

Administration of nifedipine (OR, 0.27; 95 percent CI, 0.14–0.55), methyldopa (OR, 0.31; 95 percent CI, 0.17–0.56), ketanserin (OR, 0.29; 95 percent CI, 0.09–0.90), and pindolol (OR, 0.17; 95 percent CI, 0.05–0.55) resulted in a significantly lower incidence of severe hypertension compared with no drug intake. Probability scores were highest for furosemide (p=0.86), amlodipine (p=0.82), and placebo (p=0.82).

Treatment with nifedipine (OR, 0.29, 95 percent CI, 0.15–0.58) and methyldopa (OR, 0.23, 95 percent CI, 0.11–0.46) correlated with significantly lower placental abruption rates. No significant differences were estimated for caesarean delivery, perinatal death, preterm birth, and gestational age at delivery.

“Future large-scale trials should provide guidance about the choice of antihypertensive treatment and the goal blood pressure during pregnancy,” the investigators said.