***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The effect of intravenous infusion of labetalol and of dihydralazine in increasing doses was compared in 12 women with severe hypertension in pregnancy . In 5 our of 6 women  labetalol produced a smooth , progressive fall in blood pressure to normal levels with minimal side effects . In 2 our of 6 women on dihydralazine the blood pressure control was satisfactory but in the remaining 4 patients treatment had to by discontinued because of unpredictable , sudden falls in blood pressure . One of the 6 infants of mothers treated with labetalol manifested signs of adrenergic blockade . Continuous infusion of labetalol appears to offer significant advantages in the management of severe  hypertension  in pregnancy and merits further trial Summary : The results of a prospect i ve trial to evaluate the use of diazoxide and labetalol given intravenously in the management of  severe hypertensive disease in pregnancy are presented OBJECTIVE Determine the definitive position of ketanserin and dihydralazine for treatment of  severe hypertension in pregnancy . STUDY DESIGN A single centre double blind r and omized controlled trial was performed at the obstetrical tertiary high care unit of the University Medical Centre in Rotterdam , the Netherl and s. Women with severe hypertension in pregnancy ( diastolic blood pressure (DBP)≥110mmHg ) , and significant proteinuria ( ≥300mg/24h ) , and gestational age≤32 weeks were eligible for the study . All patients ( n=30 ) received two infusions ( double dummy technique ) : one contained the active ingredient ( ketanserin or dihydralazine ) , the other was used for placebo . Nicardipine was used as rescue medication . The main outcome measures were persistent severe hypertension ( DBP>100mmHg>120min ) despite maximum dosage of study medication and prolongation of pregnancy . RESULTS Dihydralazine was significantly more effective in lowering blood pressure than ketanserin . No significant difference in prolongation of pregnancy was seen between the two groups . After 30 inclusion s , the study was stopped because of the high rate of persistent hypertension using ketanserin and the high rate of maternal side effects using dihydralazine and the apparent succesful use of the rescue drug nicardipine . CONCLUSIONS Our results do not support the use of either dihydralazine or ketanserin for the treatment of severe hypertension in pregnancy . Future research is needed to compare nicardipine with other antihypertensive drugs currently in use for treatment of severe hypertension in pregnancy OBJECTIVES The purpose s of this study were to compare the efficacy of sublingual nifedipine with intravenous hydrallazine in the control of acute hypertension of pregnancy and to make a preliminary assessment whether sublingual nifedipine could be recommended for use by midwives faced with severe hypertension in pregnancy in a rural setting . METHODS Subjects were 200 consecutive patients admitted to Kuala Tereng-ganu General Hospital , Malaysia with severe hypertension in pregnancy between August 1989 and June 1990 . Admission criteria were an ongoing viable pregnancy more than 28 weeks and diastolic blood pressure ( DBP ) more than 120 mmHg . The patients were r and omly divided into 2 groups . In group I , sublingual nifedipine 5 mg was administered and repeated after 15 minutes if DBP > 120 mmHg ; and in group II hydrallazine 5 mg was intravenously injected and repeated after 15 minutes if DBP > 120 mmHg . Both groups were put on hydrallazine infusion if DBP > 120 mmHg after 30 minutes . The Chi-square test was used for analysis with significance at p < 0.05 . RESULTS There was no statistical difference in the efficacy of therapy for decreasing blood pressure between the 2 groups . The groups were comparable by age , parity , gestational age at presentation , birth weight of infants , incidence of postpartum haemorrhage and fetal distress . Caesarian section rates were similar . In the observational studies on nurses administering the drugs , no significant difficulties were observed . CONCLUSION Sublingual nifedipine was comparable to IV hydrallazine in the treatment of acute hypertension of pregnancy . Nurses were able to administer lingual nifedipine without difficulty Objective Preeclampsia ( PE ) is a complication affecting pregnant women worldwide , which usually manifests as severe maternal hypertension . Resveratrol ( RESV ) , a naturally existing polyphenol , is known to exhibit beneficial effects in cardiovascular disease including hypertension . We evaluated the outcome of treatment combining oral nifedipine ( NIFE ) and RESV against PE . Design and methods Using a r and omized group assignment , 400 PE patients were enrolled and received oral treatments of either NIFE + RESV or NIFE + placebo . Primary endpoints were defined as time to control blood pressure and time before a new hypertensive crisis . Secondary endpoints were defined as the number of doses needed to control blood pressure , maternal and neonatal adverse effects . Results Compared with the NIFE + placebo group , the time needed to control blood pressure was significantly reduced in NIFE + RESV group , while time before a new hypertensive crisis was greatly delayed in NIFE + RESV group . The number of treatment doses needed to control blood pressure was also categorically lower in NIFE + RESV group . No differences in maternal or neonatal adverse effects were observed between the two treatment groups . Conclusion Our data support the potential of RESV as a safe and effective adjuvant of oral NIFE to attenuate hypertensive symptoms among PE patients AIMS Diazoxide is one of few available agents for treatment of hypertensive emergencies in pregnancy . From previous studies , there is a question concerning safety after moderate-dose administration caused episodes of hypotension . Rapid control of severe hypertension is necessary to reduce maternal morbidity , for example , stroke and placental abruption . This study was design ed to compare the efficacy of mini-bolus diazoxide with intravenous ( i.v . ) hydralazine . DESIGN A r and omised controlled trial . SETTING Tertiary referral maternity hospital , Royal Prince Alfred Women and Babies , Sydney Australia . POPULATION Antenatal and postnatal women with severe hypertension . METHODS One hundred and twenty-four hypertensive women were r and omised to either i.v . hydralazine ( 5 mg doses ) or  mini-bolus diazoxide  ( 15 mg doses ) . PRIMARY OUTCOME MEASURE Achievement of target blood pressure reduction ; secondary measures included requirement for Caesarean section because of fetal deterioration as determined by non-reassuring cardiotocograph ( CTG ) . RESULTS Reduction in systolic and diastolic blood pressure was 34 min for hydralazine and 19 min for diazoxide ( P < 0.001 ) . There were no episodes of hypotension after diazoxide and one after hydralazine ( after epidural ) . Episodes of persistent severe hypertension were more common with hydralazine ( 38 % ) than with diazoxide ( 16 % ) , P < 0.01 . The Caesarean section rate for no-reassuring CTG was no different between the two groups . Neonatal outcomes were similar . CONCLUSION Diazoxide and hydralazine are safe and effective antihypertensives , showing a controlled and comparable blood pressure reduction in women with hypertensive emergencies in pregnancy . The mini-bolus doses of 15 mg of diazoxide did not precipitate maternal hypotension as previously described and reduces episodes of persistent severe hypertension Vitamin D ( VD ) has exhibited immunomodulatory role in the pathogenesis of preeclampsia . We hypothesize VD potentiate nifedipine treatment for preeclampsia by shortened the time to control blood pressure and prolong time before subsequent hypertensive crisis . We conduct a r and omized trial of 683 primigravid women with preeclampsia , who were assigned to different treatment groups , either nifedipine+placebo or nifedipine+VD orally , by r and om after screening . Primary endpoints include time to control hypertension and time before another hypertensive crisis . Maternal adverse effects including nausea , vomiting , chest pain , mild headache , dizziness , maternal tachycardia , hypotension or shortness of breath , and neonatal parameters including birth weight and Apgar scores , as well as the minimum number of dosages needed to control hypertension were defined as secondary endpoints . Serum levels of cytokines tumor necrosis factor-α ( TNF-α ) and interleukin-10 ( IL-10 ) were also examined . There was a marked reduction of the time required to control hypertension and a significant lengthening ( p = 0.013 ) of the time before a new hypertensive crisis in participants received nifedipine+VD treatments ( 41.8 ± 18.3 min ) , in comparison with the nifedipine+placebo controls ( 61.1 ± 15.9 min ) . In women treated with nifedipine+VD , the minimum number of dosages needed to control hypertension was also lower . With regard to adverse effects , no statistical difference was observed between the two treatment groups . Moreover , treatment  with  VD increased IL-10 and reduced TNF-α serum levels . VD possesses the potential of serving as a safe and effective adjuvant to oral nifedipine in treating women with preeclampsia against hypertension , possibly through the upregulation of IL-10 and the downregulation of TNF-α OBJECTIVE The objective was to compare the safety and efficacy of intravenous labetalol and intravenous hydralazine for acutely lowering blood pressure in pregnancy . STUDY DESIGN Two hundred women with severe hypertension in pregnancy were r and omized to receive hydralazine ( 5 mg as a slow bolus dose given intravenously , and repeated every 20 min up to a maximum of five doses ) or labetalol ( 20-mg intravenous bolus dose followed by 40 mg if not effective within 20 min , followed by 80 mg every 20 min up to a maximum dose of 300 mg ) . The primary end point was successful lowering of blood pressure and maternal hypotension . RESULTS Women were similar with respect to characteristics at r and omization . No significant differences were observed for maternal hypotension or persistent severe hypertension ; only two patients in the hydralazine group presented with hypotension . Palpitations ( p=0.01 ) and maternal tachycardia ( p=0.05 ) occurred significantly more often in patients treated with hydralazine . The main neonatal outcomes were very similar per group ; however , hypotension and bradycardia were significantly more frequent in the labetalol group . There were two neonatal deaths per antihypertensive drug group . CONCLUSIONS This r and omized clinical trial shows that labetalol and hydralazine fulfill the criteria required for an antihypertensive drug to treat severe hypertension in pregnancy Abstract Objective : Using noninvasive bedside impedance cardiography ( ICG ) , we compared the effectiveness and the hemodynamic impact of intravenous labetalol versus hydralazine for the reduction of acute-onset severe hypertension to ACOG-recommended blood pressure levels ( ACOG Committee Opinion 514 ) . Study design : In this prospect i ve r and omized pilot study of acutely severe systolic hypertension ( ≥160 mmHg ) , pregnant women received either labetalol ( L ) or hydralazine ( H ) intravenously and underwent thoracic ICG before and after treatment . Data analysis were performed using STATA software ( StataCorp LP , College Station , TX ) ; data are expressed as mean ± SD . Results : About 29 patients completed the study . There was no significant difference in mean arterial pressure ( MAP ) between groups [ H = 119.4 mmHg , L = 117.7 mmHg , mean difference ( MD ) = 1.73 ) ; the estimated MD between baseline and follow-up ICG was −9.17 ( p = 0.001 , 95 % CI : −14.39 to −3.95 ) . There were no significant differences in total peripheral resistance ( TPR ) between groups ( H = 1771.3 , L = 1976.97 , MD = 205.62 ) or cardiac output ( CO ) between groups ( H = 5.7 , L = 5.1 , MD = 0.64 ) or a significant MD between these at baseline and follow-up . Conclusion : Both drugs performed similarly to achieve ACOG-recommended initial blood pressure reduction safely without side effects or excessive acute hemodynamic profile correction toward normal pregnancy values OBJECTIVE This executive summary presents in brief the current evidence assessed in the clinical practice guideline prepared by the Canadian Hypertensive Disorders of Pregnancy Working Group and published by Pregnancy Hypertension ( http://www.pregnancyhypertension.org/article/S2210-7789(14)00004-X/fulltext ) to provide a reasonable approach to the diagnosis , evaluation , and treatment of the hypertensive disorders of pregnancy . EVIDENCE Published literature was retrieved through search es of Medline , CINAHL , and The Cochrane Library in March 2012 using appropriate controlled vocabulary ( e.g. , pregnancy , hypertension , pre-eclampsia , pregnancy toxemias ) and key words ( e.g. , diagnosis , evaluation , classification , prediction , prevention , prognosis , treatment , postpartum follow-up ) . Results were restricted to systematic review s , r and omized control trials , controlled clinical trials , and observational studies published in French or English between January 200 
    Output:
    
Diazoxide [ -15 ( -20.6 , -9.4 ) ] , nicardipine [ -11.8 ( -22.3 , -1.2 ) ] , nifedipine/celastrol [ -19.3 ( -27.4 , -11.1 ) ] , nifedipine/vitamin D [ -17.1 ( -25.7 , -9.7 ) ] , nifedipine/resveratrol [ -13.9 ( -22.6 , -5.2 ) ] and glyceryl trinitrate [ -33.8 ( -36.7 , -31 ) ] were observed to achieve the target BP ( in minutes ) more rapidly than hydralazine .
Nifedipine required fewer doses than hydralazine for achieving the target BP .
Glyceryl trinitrate and labetalol were associated with fewer incidences of tachycardia and palpitation respectively than hydralazine .
Trial sequential analysis concluded adequate evidence for hydralazine and nifedipine compared with labetalol .
The present evidence suggests similar efficacy between nifedipine , hydralazine and labetalol in the treatment of severe hypertension in pregnancy .
Subtle differences may exist in their safety profile .