human
***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 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 The purpose of this study was to compare the efficacy of nifedipine ( Cordipin ) and hydralazine in lowering blood pressure in severe preeclampsia . METHOD A r and omized , prospect i ve study of 104 patients with severe preeclampsia in the Department of Obstetrics and Gynecology , Korle-Bu Teaching Hospital , Accra , Ghana , was conducted between January 1992 and June 1994 . RESULTS Of the 104 patients recruited into the study , six did not deliver at our hospital and were thus excluded from the study .  Nifedipine and hydralazine as first-line drugs controlled the blood pressure in 44 and 35 patients , respectively , but failed in 5 and 14 , respectively . This was statistically significant ( P < 0.05 ) . The mean birth weight was higher in the nifedipine group ( 2500+/-800 g vs. 2400+/-800 g ) . There were 11 admissions to the neonatal intensive care unit in the nifedipine group and 13 in the hydralazine group but the difference was not statistically significant . CONCLUSION Nifedipine and hydralazine could both be used effectively to control blood pressure in severe preeclampsia in our subregion . While hydralazine is administered intravenously and needs strict monitoring , nifedipine is more effective , is easy to administer orally , less dem and ing on hospital staff , convenient and more predictable Pre-eclampsia is an extremely severe condition . It is associated with vasospasm , activation of the coagulation system and abnormal haemostasis . In pre-eclamptic patients increased plasmatic concentrations of fibronectin , laminin , von Willebr and factor ( VWF ) and endothelin are observed . Experimental studies on rats have also shown that the doses of antithrombin III ( AT ) needed to mediate anti-inflammatory processes are much higher than those required to obtain the anti-coagulant effect . The study aim ed to evaluate the clinical efficacy of treatment with high AT doses ( HD ) in comparison with st and ard doses ( SD ) . The primary endpoint was the prolongation of pregnancy defined as time ( in days ) from enrollment to delivery and to assess the maternal bleeding at and after delivery . The secondary endpoint was to demonstrate a role for AT in controlling haemostasis at conventional doses , and the inflammatory state at higher doses . The biochemical parameters assessed were : AT activity ( % ) , Fibronectin ( Fn ) , Fibrinogen , D-dimer , Uricemia , Proteinuria 24h , Protein C Reactive ( PCR ) , Granulocyte Elastase and Endothelin . This study included 23 pre-eclamptic women . Patients were r and omly subdivided into two groups : 10 patients ( " cases " ) were treated with high doses of AT ( 6 vials : 3000 units ) once daily for 5 days , or until delivery , while 13 women ( " controls " ) were treated with doses of AT sufficient to maintain at least 80 % of the activity . High-dose therapy was associated with prolongation of pregnancy by 2.5 days more when compared with controls ( p = 0.03 ; Mann-Whitney test ) . The incidence of clinical significant bleeding was lower in cases than in controls ( mean 550 mL vs. 650 mL , respectively ) . Preventive- and conservative-type treatment of moderate-severe pre-eclampsia , based on the administration high doses of AT , allows a significant prolongation of pregnancy , and thus a better neonatal outcome , as well as less maternal intra- and post-operative bleeding . Fn , PCR and elastase levels ( markers of inflammation ) decrease in the HD group in comparison with SD group . In the HD group , the AT plasma levels were obviously higher both at the end of the treatment ( p < 0.0001 ) and after delivery ( p = 0.03 ) , in comparison with SD group . The fibrinogen and D-dimer levels were above the reference interval in both groups . TPA and PAI 1 were found to be significantly raised in the course of pre-eclampsia . In conclusion , the bio-chemical findings support a role for AT in controlling the haemostasis at conventional doses , and the inflammatory state at higher doses OBJECTIVE To evaluate the safety of long-term nicardipine treatment in severely pre-eclamptic women and their fetuses/newborns . METHODS We divided 50 pregnant women into three groups according to the length of their treatment : short-term treatment of severely pre-eclamptic women ( 7 days or less , n=20 ) ; medium-term treatment also of severely pre-eclamptic women ( 8 - 28 days , n=20 ) ; and long-term treatment of women with severe superimposed pre-eclampsia ( 29 days or more , n=10 ) . RESULTS Nicardipine significantly lowered both systolic ( P<0.01 ) and diastolic blood pressures ( P<0.025 ) in all three groups . The incidence of delivery before 28 weeks of gestation was very low in all three groups . There were no maternal or fetal/neonatal adverse effects . CONCLUSION Our results suggest that long-term treatment with nicardipine for severe pre-eclampsia is as effective and safe as a short- and medium-term treatment The administration of diazoxide to patients with severe hypertension in pregnancy in 60 and 150 mg doses , which are smaller than the usual 300 mg dose , is described . A 60 mg dose is effective and does not cause the undesirable hypotension occasionally produced by larger doses We hypothesised that long term epidural anaesthesia suppresses sympathetic overactivity in pre-eclampsia . Two equal groups of severe pre-eclamptic patients were treated either with long-term epidural anaesthesia ( epidural group ) or bed rest , diet control , and an antihypertensive drug ( control group ) . After 7 days of epidural block , mean arterial blood pressures decreased , platelet count and serum total protein increased in all cases while proteinuria decreased in four cases . All patients treated with a long-term epidural therapy continued their pregnancies for more than 3 weeks after admission . The infants in the epidural group had 1-min Apgar scores above 8 , a body weight of 2240 ± 310 g ( mean ± s.d . ) and normal neonatal progress . In contrast , the pregnancies of eight patients in the control group were terminated within 2 weeks of admission due to severe pre-eclampsia or foetal distress , the birth weight of the infants was 1590 ± 380 g ( mean ± s.d . ) and four had neonatal distress . Progressive worsening in the mean arterial pressure , proteinuria , platelet count and serum total protein was found in these patients . Long-term epidural anaesthesia suppresses the sympathetic hyperactivity and thus improves pre-eclamptic condition  which may open a new treatment in case of progressive severe pre-eclampsia This prospect i ve study was conducted at Dhaka Medical College and Hospital , Bangladesh . The objective was to identify the time required to control high blood pressure levels in obstetric patients by injection of hydralazine in a bolus intravenous dose vs continuous drip .  Seventy-seven patients with eclampsia and hypertensive emergencies comprised the target population . Patients were managed either by hydralazine drip in normal saline ( existing official protocol , n = 33 ) or hydralazine bolus injection ( as experiment , n = 44 ) until diastolic blood pressure fell to 90 - 95 mmHg . Results were compared . Student 's t-test was done for statistical significance , and a P value of < .05 was considered as significant . The groups were similar with respect to maternal age and their mean systolic and diastolic blood pressure  at the time of enrollment . Patients who received bolus injection required less time to achieve the therapeutic goal ( 65.23 + /- 23.38 minutes ) than continuous drip ( 186.36 + /- 79.77 minutes ; P < .001 ) . The experimental group also required significantly lower doses ( 6.68 + /- 1.66 mg ) in comparison to that required by control group ( 20.07 + /- 11.38 mg ; P < .001 ) . There was no overshoot hypotension in either group . The data suggest that hydralazine bolus dose is equally safe and more effective than continuous drip in the management of hypertensive emergencies in pregnancy BACKGROUND The primary objective of treatment in women with severe hypertension and pre-eclampsia is to prevent complications such as encephalopathy and haemorrhage . In many countries dihydralazine is considered the drug of choice for treating hypertension in pregnancy , because it now has been used safely for about 30 years , and the introduction of a new drug in pregnancy is a difficult task with partially unknown hazards . In some other countries combined alpha- and beta-blockers are also used . Taking into account that some patients with pre-eclampsia do not respond to dihydralazine and the drug has serious side-effects like headache and reflex tachycardia , there is some need for developing alternative treatment strategies using drugs that are more adequate for pregnancy than dihydralazine . METHODS Urapidil is a post-synaptic alpha 1 adrenoceptor antagonist , which is widely used to control hypertensive crises unrelated to pregnancy . Since it is known that pre-eclampsia is associated with increased sympathetic activity , administration of an alpha 1 adrenoceptor antagonist provides a reasonable therapeutic basis . So far there is only one report describing the i.v . use of urapidil in the treatment of hypertension in pregnancy unresponsive to dihydralazine and one report which describes the oral use of urapidil . In an earlier pilot study we examined the dose range for i.v . application of urapidil necessary for adequate blood pressure control in patients with pre-eclampsia . In the present r and omized controlled study 26 white women with pre-eclampsia and hypertension in pregnancy were included . Treatment was not blinded . During the initial period of intensive intravenous treatment all subjects were under constant surveillance by a physician and a nurse . RESULTS Effective prolonged control of blood pressure ( values below 150/100 mmHg ) was achieved in all patients of the two groups . In one patient of the dihydralazine group signs of lightheadedness and near syncope were noted . After this side-effect of dihydralazine the patient was treated with urapidil . At the end of the observation period the maternal heart rate in the dihydralazine group was higher than in the urapidil group . CONCLUSIONS Since urapidil decreased the high blood pressure in patients with pre-eclampsia without serious side-effects urapidil appears preferable superior to dihydralazine . The haemodynamic effects of urapidil were more predictable than those of dihydralazine . The reduction of intracerebral pressure could be an additional 
    Output:
    
agent
Hydralazine was the most common drug for others to be evaluated against .
Diazoxide , given as 75 mg bolus injections , appears to be associated with maternal hypotension requiring treatment , and ketanserin is less effective than hydralazine at reducing blood pressure .
There is no other clear evidence that any one of the other antihypertensive agents is better than another for women with severe hypertension during pregnancy .
Exceptions are diazoxide and ketanserin , which are probably not good choices
***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 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 The purpose of this study was to compare the efficacy of nifedipine ( Cordipin ) and hydralazine in lowering blood pressure in severe preeclampsia . METHOD A r and omized , prospect i ve study of 104 patients with severe preeclampsia in the Department of Obstetrics and Gynecology , Korle-Bu Teaching Hospital , Accra , Ghana , was conducted between January 1992 and June 1994 . RESULTS Of the 104 patients recruited into the study , six did not deliver at our hospital and were thus excluded from the study .  Nifedipine and hydralazine as first-line drugs controlled the blood pressure in 44 and 35 patients , respectively , but failed in 5 and 14 , respectively . This was statistically significant ( P < 0.05 ) . The mean birth weight was higher in the nifedipine group ( 2500+/-800 g vs. 2400+/-800 g ) . There were 11 admissions to the neonatal intensive care unit in the nifedipine group and 13 in the hydralazine group but the difference was not statistically significant . CONCLUSION Nifedipine and hydralazine could both be used effectively to control blood pressure in severe preeclampsia in our subregion . While hydralazine is administered intravenously and needs strict monitoring , nifedipine is more effective , is easy to administer orally , less dem and ing on hospital staff , convenient and more predictable Pre-eclampsia is an extremely severe condition . It is associated with vasospasm , activation of the coagulation system and abnormal haemostasis . In pre-eclamptic patients increased plasmatic concentrations of fibronectin , laminin , von Willebr and factor ( VWF ) and endothelin are observed . Experimental studies on rats have also shown that the doses of antithrombin III ( AT ) needed to mediate anti-inflammatory processes are much higher than those required to obtain the anti-coagulant effect . The study aim ed to evaluate the clinical efficacy of treatment with high AT doses ( HD ) in comparison with st and ard doses ( SD ) . The primary endpoint was the prolongation of pregnancy defined as time ( in days ) from enrollment to delivery and to assess the maternal bleeding at and after delivery . The secondary endpoint was to demonstrate a role for AT in controlling haemostasis at conventional doses , and the inflammatory state at higher doses . The biochemical parameters assessed were : AT activity ( % ) , Fibronectin ( Fn ) , Fibrinogen , D-dimer , Uricemia , Proteinuria 24h , Protein C Reactive ( PCR ) , Granulocyte Elastase and Endothelin . This study included 23 pre-eclamptic women . Patients were r and omly subdivided into two groups : 10 patients ( " cases " ) were treated with high doses of AT ( 6 vials : 3000 units ) once daily for 5 days , or until delivery , while 13 women ( " controls " ) were treated with doses of AT sufficient to maintain at least 80 % of the activity . High-dose therapy was associated with prolongation of pregnancy by 2.5 days more when compared with controls ( p = 0.03 ; Mann-Whitney test ) . The incidence of clinical significant bleeding was lower in cases than in controls ( mean 550 mL vs. 650 mL , respectively ) . Preventive- and conservative-type treatment of moderate-severe pre-eclampsia , based on the administration high doses of AT , allows a significant prolongation of pregnancy , and thus a better neonatal outcome , as well as less maternal intra- and post-operative bleeding . Fn , PCR and elastase levels ( markers of inflammation ) decrease in the HD group in comparison with SD group . In the HD group , the AT plasma levels were obviously higher both at the end of the treatment ( p < 0.0001 ) and after delivery ( p = 0.03 ) , in comparison with SD group . The fibrinogen and D-dimer levels were above the reference interval in both groups . TPA and PAI 1 were found to be significantly raised in the course of pre-eclampsia . In conclusion , the bio-chemical findings support a role for AT in controlling the haemostasis at conventional doses , and the inflammatory state at higher doses OBJECTIVE To evaluate the safety of long-term nicardipine treatment in severely pre-eclamptic women and their fetuses/newborns . METHODS We divided 50 pregnant women into three groups according to the length of their treatment : short-term treatment of severely pre-eclamptic women ( 7 days or less , n=20 ) ; medium-term treatment also of severely pre-eclamptic women ( 8 - 28 days , n=20 ) ; and long-term treatment of women with severe superimposed pre-eclampsia ( 29 days or more , n=10 ) . RESULTS Nicardipine significantly lowered both systolic ( P<0.01 ) and diastolic blood pressures ( P<0.025 ) in all three groups . The incidence of delivery before 28 weeks of gestation was very low in all three groups . There were no maternal or fetal/neonatal adverse effects . CONCLUSION Our results suggest that long-term treatment with nicardipine for severe pre-eclampsia is as effective and safe as a short- and medium-term treatment The administration of diazoxide to patients with severe hypertension in pregnancy in 60 and 150 mg doses , which are smaller than the usual 300 mg dose , is described . A 60 mg dose is effective and does not cause the undesirable hypotension occasionally produced by larger doses We hypothesised that long term epidural anaesthesia suppresses sympathetic overactivity in pre-eclampsia . Two equal groups of severe pre-eclamptic patients were treated either with long-term epidural anaesthesia ( epidural group ) or bed rest , diet control , and an antihypertensive drug ( control group ) . After 7 days of epidural block , mean arterial blood pressures decreased , platelet count and serum total protein increased in all cases while proteinuria decreased in four cases . All patients treated with a long-term epidural therapy continued their pregnancies for more than 3 weeks after admission . The infants in the epidural group had 1-min Apgar scores above 8 , a body weight of 2240 ± 310 g ( mean ± s.d . ) and normal neonatal progress . In contrast , the pregnancies of eight patients in the control group were terminated within 2 weeks of admission due to severe pre-eclampsia or foetal distress , the birth weight of the infants was 1590 ± 380 g ( mean ± s.d . ) and four had neonatal distress . Progressive worsening in the mean arterial pressure , proteinuria , platelet count and serum total protein was found in these patients . Long-term epidural anaesthesia suppresses the sympathetic hyperactivity and thus improves pre-eclamptic condition  which may open a new treatment in case of progressive severe pre-eclampsia This prospect i ve study was conducted at Dhaka Medical College and Hospital , Bangladesh . The objective was to identify the time required to control high blood pressure levels in obstetric patients by injection of hydralazine in a bolus intravenous dose vs continuous drip .  Seventy-seven patients with eclampsia and hypertensive emergencies comprised the target population . Patients were managed either by hydralazine drip in normal saline ( existing official protocol , n = 33 ) or hydralazine bolus injection ( as experiment , n = 44 ) until diastolic blood pressure fell to 90 - 95 mmHg . Results were compared . Student 's t-test was done for statistical significance , and a P value of < .05 was considered as significant . The groups were similar with respect to maternal age and their mean systolic and diastolic blood pressure  at the time of enrollment . Patients who received bolus injection required less time to achieve the therapeutic goal ( 65.23 + /- 23.38 minutes ) than continuous drip ( 186.36 + /- 79.77 minutes ; P < .001 ) . The experimental group also required significantly lower doses ( 6.68 + /- 1.66 mg ) in comparison to that required by control group ( 20.07 + /- 11.38 mg ; P < .001 ) . There was no overshoot hypotension in either group . The data suggest that hydralazine bolus dose is equally safe and more effective than continuous drip in the management of hypertensive emergencies in pregnancy BACKGROUND The primary objective of treatment in women with severe hypertension and pre-eclampsia is to prevent complications such as encephalopathy and haemorrhage . In many countries dihydralazine is considered the drug of choice for treating hypertension in pregnancy , because it now has been used safely for about 30 years , and the introduction of a new drug in pregnancy is a difficult task with partially unknown hazards . In some other countries combined alpha- and beta-blockers are also used . Taking into account that some patients with pre-eclampsia do not respond to dihydralazine and the drug has serious side-effects like headache and reflex tachycardia , there is some need for developing alternative treatment strategies using drugs that are more adequate for pregnancy than dihydralazine . METHODS Urapidil is a post-synaptic alpha 1 adrenoceptor antagonist , which is widely used to control hypertensive crises unrelated to pregnancy . Since it is known that pre-eclampsia is associated with increased sympathetic activity , administration of an alpha 1 adrenoceptor antagonist provides a reasonable therapeutic basis . So far there is only one report describing the i.v . use of urapidil in the treatment of hypertension in pregnancy unresponsive to dihydralazine and one report which describes the oral use of urapidil . In an earlier pilot study we examined the dose range for i.v . application of urapidil necessary for adequate blood pressure control in patients with pre-eclampsia . In the present r and omized controlled study 26 white women with pre-eclampsia and hypertension in pregnancy were included . Treatment was not blinded . During the initial period of intensive intravenous treatment all subjects were under constant surveillance by a physician and a nurse . RESULTS Effective prolonged control of blood pressure ( values below 150/100 mmHg ) was achieved in all patients of the two groups . In one patient of the dihydralazine group signs of lightheadedness and near syncope were noted . After this side-effect of dihydralazine the patient was treated with urapidil . At the end of the observation period the maternal heart rate in the dihydralazine group was higher than in the urapidil group . CONCLUSIONS Since urapidil decreased the high blood pressure in patients with pre-eclampsia without serious side-effects urapidil appears preferable superior to dihydralazine . The haemodynamic effects of urapidil were more predictable than those of dihydralazine . The reduction of intracerebral pressure could be an additional 
    Output:
    