{"id":"a20ff4a5a85e","type":"article","url":"https://hartvaat.nl/2022/03/01/orale-antihypertensiva-bij-niet-ernstige-zwangerschapshypertensie-netwerkmeta-an/","title":"Orale antihypertensiva bij niet-ernstige zwangerschapshypertensie: netwerkmeta-analyse","title_en":"Oral Antihypertensives for Nonsevere Pregnancy Hypertension: Systematic Review, Network Meta- and Trial Sequential Analyses.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.18415","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.18415","authors":["Jeffrey N Bone","Akshdeep Sandhu","Edgardo D Abalos","Asma Khalil","Joel Singer","Sarina Prasad","Shazmeen Omar","Marianne Vidler","Peter von Dadelszen","Laura A Magee"],"significance":6,"published":"2022-03-01","source_date":"2022-03-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/","https://hartvaat.nl/kennis/hypertensie/centrale-middelen-hypertensie/"],"congress":"","summary_en":"This network meta-analysis evaluated oral antihypertensives for non-severe pregnancy hypertension, comparing different drug classes to identify the most effective and safe agents for blood pressure control during pregnancy.","created":"2026-07-03T10:29:38Z","updated":"2026-07-03T18:38:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Netwerkmeta-analyse van orale antihypertensiva bij niet-ernstige hypertensie in de zwangerschap.","abstract_original":"BACKGROUND: We aimed to address which antihypertensives are superior to placebo/no therapy or another antihypertensive for controlling nonsevere pregnancy hypertension and provide future sample size estimates for definitive evidence. METHODS: Randomized trials of antihypertensives for nonsevere pregnancy hypertension were identified from online electronic databases, to February 28, 2021 (registration URL: https://www.crd.york.ac.uk/PROSPERO/; unique identifier: CRD42020188725). Our outcomes were severe hypertension, proteinuria/preeclampsia, fetal/newborn death, small-for-gestational age infants, preterm birth, and admission to neonatal care. A Bayesian random-effects model generated estimates of direct and indirect treatment comparisons. Trial sequential analysis informed future trials needed. RESULTS: Of 1246 publications identified, 72 trials were included; 61 (6923 women) were informative. All commonly prescribed antihypertensives (labetalol, other β-blockers, methyldopa, calcium channel blockers, and mixed/multi-drug therapy) versus placebo/no therapy reduced the risk of severe hypertension by 30% to 70%. Labetalol decreased proteinuria/preeclampsia (odds ratio, 0.73 [95% credible interval, 0.54-0.99]) and fetal/newborn death (odds ratio, 0.54 [0.30-0.98]) compared with placebo/no therapy, and proteinuria/preeclampsia compared with methyldopa (odds ratio, 0.66 [0.44-0.99]) and calcium channel blockers (odds ratio, 0.63 [0.41-0.96]). No other differences were identified, but credible intervals were wide. Trial sequential analysis indicated that 2500 to 10 000 women/arm (severe hypertension or safety outcomes) to >15 000/arm (fetal/newborn death) would be required to provide definitive evidence. CONCLUSIONS: In summary, all commonly prescribed antihypertensives in pregnancy reduce the risk of severe hypertension, but labetalol may also decrease proteinuria/preeclampsia and fetal/newborn death. Evidence is lacking for many other safety outcomes. Prohibitive sample sizes are required for definitive evidence. Real-world data are needed to individualize care."}