Background: Hypertension in pregnancy causes significant maternal and fetal mortality and morbidity. A comprehensive assessment of the effectiveness of antihypertensive drugs for severe hypertension during pregnancy is needed to make informed decisions in clinical practice. This systematic review aimed to assess the efficacy and safety of antihypertensive drugs in severe hypertension during pregnancy. Methods: A systematic review using the electronic databases MEDLINE (PubMed) and Cochrane Library was performed until August 2021. The risk-of-bias 2 tool was used to assess the risk-of-bias in each study included. Meta-analysis was conducted to assess heterogeneity and to estimate the pooled effects size. Results: Seventeen studies fulfilled the inclusion criteria and 11 were included in the meta-analysis. Nifedipine was estimated to have a low risk in persistent hypertension compared to hydralazine (RR 0.40, 95% CI 0.23–0.71) and labetalol (RR 0.71, 95% CI 0.52–0.97). Dihydralazine was associated with a lower risk of persistent hypertension than ketanserin (RR 5.26, 95% CI 2.01–13.76). No difference was found in the risk of maternal hypotension, maternal and fetal outcomes, and adverse effects between antihypertensive drugs, except for dihydralazine, which was associated with more adverse effects than ketanserin. Conclusions: Several drugs can be used to treat severe hypertension in pregnancy, including oral/sublingual nifedipine, IV/oral labetalol, oral methyldopa, IV hydralazine, IV dihydralazine, IV ketanserin, IV nicardipine, IV urapidil, and IV diazoxide. In addition, nifedipine may be preferred as the first-line agent. There was no difference in the risk of maternal hypotension, maternal and fetal outcomes, and adverse effects between the drugs, except for adverse effects in IV dihydralazine and IV ketanserin.

Resiko komplikasi dan perburukan luaran maternal dan fetal yang terjadi akibat hipertensi selama kehamilan dapat dicegah dengan pengendalian tekanan darah melalui terapi antihipertensi. Tujuan dari studi ini adalah untuk memberikan gambaran penggunaan obat antihipertensi berdasarkan efikasi dan keamanannya pada kasus hipertensi selama kehamilan. Desain studi adalah tinjauan pustaka menggunakan basis data elektronik MEDLINE (PubMed) dan Cochrane Library yang dilakukan hingga Agustus 2021. Strategi pencarian menggunakan kata kunci sesuai dengan topik studi. Artikel diseleksi berdasarkan judul dan abstrak diikuti dengan teks lengkap sesuai kriteria inklusi dan eksklusi. Obat antihipertensi yang dapat digunakan diantaranya IV urapidil, IV dihidralazin, IV urapidil, IV nikardipin, oral metildopa, oral isradipin, oral nifedipin, oral labetalol, oral furosemid, dan oral amlodipin. Urapidil lebih baik dalam mengontrol tekanan darah tinggi dibanding dihidralazin, meskipun efek penurunan tekanan darah yang dihasilkan tidak sekuat nikardipin. Meski demikian, urapidil memiliki tolerabilitas yang lebih baik dibandingkan dengan dihidralazin dan nikardipin. Adapun metildopa tidak memiliki perbedaan yang signifikan dalam efikasi untuk menurunkan tekanan darah dibandingkan dengan labetalol dan isradipin. Terdapat beberapa pilihan obat antihipertensi yang dapat digunakan dan telah dibandingkan dalam percobaan klinis sebagai terapi hipertensi pada kasus hipertensi selama kehamilan.