{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:01:38Z","timestamp":1787756498830,"version":"build-2784847793"},"reference-count":25,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,7,13]],"date-time":"2025-07-13T00:00:00Z","timestamp":1752364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>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 = \u22121.08 min, 95% CI = \u22126.66 to 4.49), caesarean delivery (OR = 0.62, 95% CI = 0.38 to 1.03), neonatal birth weight (MD = 57.65 g, 95% CI = \u2212209.09 to \u2212324.40), NICU admissions (OR = 0.90, 95% CI = 0.41 to 1.98), and 5-min APGAR scores (MD = 0.1, 95% CI = \u22120.20 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.<\/jats:p>","DOI":"10.3390\/medsci13030091","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T13:00:51Z","timestamp":1752757251000},"page":"91","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Efficacy and Safety of Nifedipine Compared to Intravenous Hydralazine for Severe Hypertensive Disorders in Pregnancy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-1429-8176","authenticated-orcid":false,"given":"Vaisnavy","family":"Govindasamy","sequence":"first","affiliation":[{"name":"Department of Medicine, James Cook University Hospital, Middlesbrough TS4 3BW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9864-4385","authenticated-orcid":false,"given":"Mohammed Amer","family":"Kamel","sequence":"additional","affiliation":[{"name":"Department of Medicine, Al-Quds University, East Jerusalem 20002, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Volucke","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aashir","family":"Javed","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Hospital of North Durham, Durham DH1 5TW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Upayan","family":"Palchaudhuri","sequence":"additional","affiliation":[{"name":"South Tyneside and Sunderland NHS Foundation Trust, Tyne & Wear SR4 7TP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayed Irfan","family":"Kazi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Berkshire Hospital, Reading RG1 5AN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Albanna","sequence":"additional","affiliation":[{"name":"Department of Medicine, The University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mays","family":"Akileh","sequence":"additional","affiliation":[{"name":"Department of Medicine, The University of Jordan, Amman 11942, Jordan"},{"name":"Department of Medicine, King Hussein Cancer Center, Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Department of Medicine, Northumbria Specialist Emergency Care Hospital, Newcastle upon Tyne NE23 6NZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabia","family":"Nusrat","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Southend University Hospital, NHS Foundation Trust, Southend-on-Sea NW1 3AX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tayyaba","family":"Qaiser","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jinnah Sindh Medical University, Karachi 75510, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman Ibrahim","family":"Elzain Hassan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sheikh Shakhbojt Medical City, Abu Dhabi 11001, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Muneeb","family":"Azhar","sequence":"additional","affiliation":[{"name":"Sheikh Zayed Medical College, Rahim Yar Khan 64200, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6355-3907","authenticated-orcid":false,"given":"Tallal Mushtaq","family":"Hashmi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rawalpindi Medical University, Rawalpindi 46000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9872-8224","authenticated-orcid":false,"given":"Mushood","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rawalpindi Medical University, Rawalpindi 46000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Hasan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Imperial College London, London SW7 2AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2814-7314","authenticated-orcid":false,"given":"Raheel","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Imperial College London, London SW7 2AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.1038\/s41440-023-01323-w","article-title":"Preeclampsia up to date-What\u2019s going on?","volume":"46","author":"Bokuda","year":"2023","journal-title":"Hypertens. Res. Off. J. Jpn. Soc. Hypertens."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"317","DOI":"10.4103\/npmj.npmj_275_20","article-title":"Efficacy of nifedipine versus hydralazine in the management of severe hypertension in pregnancy: A randomised controlled trial","volume":"27","author":"Adebayo","year":"2020","journal-title":"Niger. Postgrad. Med. J."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Escobar, M.F., Benitez-D\u00edaz, N., Blanco-Londo\u00f1o, I., Cer\u00f3n-Garc\u00e9s, C., Pe\u00f1a-Z\u00e1rate, E.E., Guevara-Calder\u00f3n, L.A., Libreros-Pe\u00f1a, L., and Galindo, J.S. (2024). Synthesis of evidence for managing hypertensive disorders of pregnancy in low middle-income countries: A scoping review. BMC Pregnancy Childbirth, 24.","DOI":"10.1186\/s12884-024-06796-2"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.preghy.2020.01.011","article-title":"The flipside of hydralazine in pregnancy: A systematic review and meta-analysis","volume":"19","author":"Antza","year":"2020","journal-title":"Pregnancy Hypertens."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.ahj.2019.02.018","article-title":"Rationale and design of the randomized, controlled Early Valve Replacement Guided by Biomarkers of Left Ventricular Decompensation in Asymptomatic Patients with Severe Aortic Stenosis (EVOLVED) trial","volume":"212","author":"Bing","year":"2019","journal-title":"Am. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.ajog.2020.03.016","article-title":"Comparative efficacy and safety of oral antihypertensive agents in pregnant women with chronic hypertension: A network metaanalysis","volume":"223","author":"Bellos","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/j.1447-0756.1996.tb00930.x","article-title":"Sublingual nifedipine compared with intravenous hydrallazine in the acute treatment of severe hypertension in pregnancy: Potential for use in rural practice","volume":"22","author":"Jegasothy","year":"1996","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_10","first-page":"25","article-title":"Randomized, Controlled Trial of Hydralazine Versos Nifedipine in Preeclamptic Women with Acute Hypertension","volume":"11","author":"Ramos","year":"1992","journal-title":"Clin. Exp. Hypertens. B"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/0020-7292(95)02372-J","article-title":"Oral nifedipine therapy in the management of severe preeclampsia","volume":"49","author":"Kwawukume","year":"1995","journal-title":"Int. J. Gynaecol. Obstet. Off. Organ Int. Fed. Gynaecol. Obstet."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1034\/j.1600-0412.2002.810105.x","article-title":"Nifedipine or hydralazine as a first-line agent to control hypertension in severe preeclampsia","volume":"81","author":"Aali","year":"2002","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_13","first-page":"701","article-title":"Comparison of the efficacy of nifedipine and hydralazine in hypertensive crisis in pregnancy","volume":"49","author":"Rezaei","year":"2011","journal-title":"Acta Med. Iran."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"687.e1","DOI":"10.1016\/j.ajog.2017.08.018","article-title":"Hydralazine vs. nifedipine for acute hypertensive emergency in pregnancy: A randomized controlled trial","volume":"217","author":"Sharma","year":"2017","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.preghy.2014.01.003","article-title":"Canadian Hypertensive Disorders of Pregnancy (HDP) Working Group Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy","volume":"4","author":"Magee","year":"2014","journal-title":"Pregnancy Hypertens."},{"key":"ref_16","first-page":"CD001449","article-title":"Drugs for treatment of very high blood pressure during pregnancy","volume":"2013","author":"Duley","year":"2013","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_17","first-page":"CD002252","article-title":"Antihypertensive drug therapy for mild to moderate hypertension during pregnancy","volume":"10","author":"Abalos","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Awaludin, A., Rahayu, C., Daud, N.A.A., and Zakiyah, N. (2022). Antihypertensive Medications for Severe Hypertension in Pregnancy: A Systematic Review and Meta-Analysis. Healthcare, 10.","DOI":"10.3390\/healthcare10020325"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/S1701-2163(15)30588-0","article-title":"Canadian Hypertensive Disorders of Pregnancy Working Group Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: Executive summary","volume":"36","author":"Magee","year":"2014","journal-title":"J. Obstet. Gynaecol. Can. JOGC"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1097\/BOR.0000000000000522","article-title":"Drug-induced lupus erythematosus: An update on drugs and mechanisms","volume":"30","author":"He","year":"2018","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"481.e1","DOI":"10.1016\/j.ajog.2008.07.048","article-title":"Diagnosis and management of atypical preeclampsia-eclampsia","volume":"200","author":"Sibai","year":"2009","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1161\/CIRCRESAHA.118.313276","article-title":"Preeclampsia: Pathophysiology, Challenges, and Perspectives","volume":"124","author":"Rana","year":"2019","journal-title":"Circ. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1097\/HJH.0000000000003194","article-title":"Practical guide for the management of hypertensive disorders during pregnancy","volume":"40","author":"Antza","year":"2022","journal-title":"J. Hypertens."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1056\/NEJMoa1404595","article-title":"CHIPS Study Group Less-tight versus tight control of hypertension in pregnancy","volume":"372","author":"Magee","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1053\/j.semperi.2009.02.010","article-title":"The global impact of pre-eclampsia and eclampsia","volume":"33","author":"Duley","year":"2009","journal-title":"Semin. Perinatol."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/13\/3\/91\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:09:15Z","timestamp":1760033355000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/13\/3\/91"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,13]]},"references-count":25,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["medsci13030091"],"URL":"https:\/\/doi.org\/10.3390\/medsci13030091","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,13]]}}}