SynthesisBMJ (Clinical research ed.)2003
Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis.
Synthesis in BMJ (Clinical research ed.), 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 81 papers, 7 of them syntheses that pooled 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.
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.
Who cites it
81 citing papers in PubMed, 7 syntheses or guidelines pooled it, 442 citations in OpenAlex.
- Pharmaceutical administration for severe hypertension during pregnancy: Network meta-analysis.Frontiers in pharmacology · 2022Pooled it
- Peripartum management of hypertension: a position paper of the ESC Council on Hypertension and the European Society of Hypertension.European heart journal. Cardiovascular pharmacotherapy · 2020Guideline
- The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019).Hypertension research : official journal of the Japanese Society of Hypertension · 2019Guideline
- ESC Council on hypertension position document on the management of hypertensive emergencies.European heart journal. Cardiovascular pharmacotherapy · 2019Guideline
- Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: a systematic review.BJOG : an international journal of obstetrics and gynaecology · 2014Pooled it
- Drugs for treatment of very high blood pressure during pregnancy.The Cochrane database of systematic reviews · 2013Pooled it
- The diagnosis and treatment of hypertensive disorders of pregnancy: new findings for antenatal and inpatient care.Deutsches Arzteblatt international · 2009Pooled it
- Lipid profile and cytokines in hypertension of pregnancy: A comparison of preeclampsia therapies.Journal of clinical hypertension (Greenwich, Conn.) · 2018Trial
- Pre-Eclampsia and Maternal Cardiovascular Function: Insights Into Pathophysiology and Care (Scientific Impact Paper No. 79).BJOG : an international journal of obstetrics and gynaecology · 2026Article
- The pathophysiology of pre-eclampsia.Nature reviews. Nephrology · 2026Review
- Phthalazine scaffolds in medicinal chemistry: a review of their synthesis, versatility, and pharmacological significance.Molecular diversity · 2026Review
- Updates in the 2025 AHA/ACC Hypertension Guideline.Current hypertension reports · 2026Review
- The Japanese Society of Hypertension Guidelines for the management of elevated blood pressure and hypertension 2025 (JSH2025).Hypertension research : official journal of the Japanese Society of Hypertension · 2026Article
- Minoxidil restores thymic growth in 22q11.2 deletion syndrome by limiting Sox9Journal of human immunity · 2025Article
- Hypertension in Pregnancy and Postpartum: Current Standards and Opportunities to Improve Care.Circulation · 2025Review
- Current Approaches and Innovations in Managing Preeclampsia: Highlighting Maternal Health Disparities.Journal of clinical medicine · 2025Review
- Hydralazine-Induced ANCA Vasculitis Presenting With Pericarditis: A Novel Case and Literature Review.Case reports in cardiology · 2025Article
- Diagnosis and Treatment of Eclampsia.Journal of cardiovascular development and disease · 2024Review
- Considering Adverse Effects of Common Antihypertensive Medications in the ED.Current hypertension reports · 2024Review
- The Pathophysiology, Prognosis and Treatment of Hypertension in Females from Pregnancy to Post-menopause: A Review.Current heart failure reports · 2024Review
21 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo review outcomes in randomised controlled trials comparing hydralazine against other antihypertensives for severe hypertension in pregnancy. STUDY
designMeta-analysis of randomised controlled trials (published between 1966 and September 2002) of short acting antihypertensives for severe hypertension in pregnancy. Independent data abstraction by two reviewers. Data were entered into RevMan software for analysis (fixed effects model, relative risk and 95% confidence interval); in a secondary analysis, risk difference was also calculated.
resultsOf 21 trials (893 women), eight compared hydralazine with nifedipine and five with labetalol. Hydralazine was associated with a trend towards less persistent severe hypertension than labetalol (relative risk 0.29 (95% confidence interval 0.08 to 1.04); two trials), but more severe hypertension than nifedipine or isradipine (1.41 (0.95 to 2.09); four trials); there was significant heterogeneity in outcome between trials and differences in methodological quality. Hydralazine was associated with more maternal hypotension (3.29 (1.50 to 7.23); 13 trials); more caesarean sections (1.30 (1.08 to 1.59); 14 trials); more placental abruption (4.17 (1.19 to 14.28); five trials); more maternal oliguria (4.00 (1.22 to 12.50); three trials); more adverse effects on fetal heart rate (2.04 (1.32 to 3.16); 12 trials); and more low Apgar scores at one minute (2.70 (1.27 to 5.88); three trials). For all but Apgar scores, analysis by risk difference showed heterogeneity between trials. Hydralazine was associated with more maternal side effects (1.50 (1.16 to 1.94); 12 trials) and with less neonatal bradycardia than labetalol (risk difference -0.24 (-0.42 to -0.06); three trials).
conclusionsThe results are not robust enough to guide clinical practice, but they do not support use of hydralazine as first line for treatment of severe hypertension in pregnancy. Adequately powered clinical trials are needed, with a comparison of labetalol and nifedipine showing the most promise.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.