Evidence map›Paper›PMID 12917933›Full record

SynthesisThe Cochrane database of systematic reviews2003

Oral beta-blockers for mild to moderate hypertension during pregnancy.

L A Magee, L Duley

Abstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in The Cochrane database of systematic reviews, 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers, 14 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
49citing papers in PubMed, 14 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

49 citing papers in PubMed, 14 syntheses or guidelines pooled it.

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  13. Bed rest with or without hospitalisation for hypertension during pregnancy.The Cochrane database of systematic reviews · 2005
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  14. Oral beta-blockers for mild to moderate hypertension during pregnancy.The Cochrane database of systematic reviews · 2000
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

2 authors.

L A MageeDivision of Internal Medicine and Specialized Women's Health, University of British Columbia, Children's and Women's Health Centre of British Columbia, 4500 Oak Street, Suite 1U59, Vancouver, British Columbia, Canada, V6H 3N1.
L Duley

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAntihypertensives, such as beta-blockers, are used for pregnancy hypertension in the belief these will improve outcome for mother and baby.

objectivesTo assess whether oral beta-blockers are better than placebo, or no beta-blocker, and have advantages over other antihypertensives, for women with mild to moderate pregnancy hypertension. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (May 2002), MEDLINE (1966 to May 2002), bibliographies of retrieved papers and personal files. SELECTION CRITERIA: Trials comparing beta-blockers with placebo or no therapy, or other antihypertensives, for women with mild to moderate pregnancy hypertension. DATA COLLECTION AND ANALYSIS: We extracted the data independently and were not blinded to trial characteristics or outcomes. Whenever possible, we contacted authors for missing data. MAIN

resultsTwenty-nine trials (approximately 2500 women) are included. Thirteen trials (1480 women) compared beta-blockers with placebo/no beta blocker. Oral beta-blockers decrease the risk of severe hypertension (relative risk (RR) 0.37, 95% confidence interval (CI) 0.26 to 0.53; 11 trials, N = 1128 women) and the need for additional antihypertensives (RR 0.44, 95% CI 0.31 to 0.62; 7 trials, N = 856 women). There are insufficient data for conclusions about the effect on perinatal mortality or preterm birth. Beta-blockers seem to be associated with an increase in small-for-gestational-age (SGA) infants (RR 1.36, 95% CI 1.02 to 1.82; 12 trials; N = 1346 women). Maternal hospital admission may be decreased, neonatal bradycardia increased and respiratory distress syndrome decreased, but these outcomes are reported in only a small proportion of trials. In 13 trials (854 women), beta-blockers were compared with methyldopa. Beta-blockers appear to be no more effective and probably equally as safe. Single small trials have compared beta-blockers with hydralazine, nicardipine or isradipine. It is unusual for women to change drugs due to side effects. REVIEWER'S

conclusionsImprovement in control of maternal blood pressure with use of beta-blockers would be worthwhile only if it were reflected in substantive benefits for mother and/or baby, and none have been clearly demonstrated. The effect of beta-blockers on perinatal outcome is uncertain; the worrying trend to an increase in SGA infants is partly dependent on one small outlying trial. Large randomised trials are needed to determine whether antihypertensive therapy in general (rather than beta-blocker therapy specifically) results in greater benefit than risk, for treatment of mild-moderate pregnancy hypertension. If so, then it would be appropriate to consider which antihypertensive is best, and beta-blockers should be evaluated.

Indexed as

Administration, OralAdrenergic beta-AntagonistsAntihypertensive AgentsFemaleHumansHypertensionPregnancyPregnancy Complications, CardiovascularRandomized Controlled Trials as TopicAdrenergic beta-AntagonistsAntihypertensive Agents

Identifiers

PMID12917933

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.