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A prediction model for the response to oral labetalol for the treatment of antenatal hypertension

Journal of Human Hypertension volume 31, pages 126–131 (2017)Cite this article

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Abstract

This prospective observational study aimed to identify at presentation the maternal hemodynamic and demographic variables associated with a therapeutic response to oral labetalol and to use these variables to develop a prediction model to anticipate the response to labetalol monotherapy in women with hypertension. It was set at a maternity unit in a UK teaching hospital. Maternal demographic data from 50 pregnant women, presenting with hypertension between January and August 2013, was collected and blood pressure measured with a device validated for pregnancy and pre-eclampsia. Maternal haemodynamics were assessed with a bioreactance monitor. Participants were commenced on oral labetalol, and reviewed until delivery and discharge home. Logistic regression analysis was performed to assess the prediction of response to labetalol according to the maternal demographic and hemodynamic variables. Main outcome measures were the response to labetalol monotherapy up to delivery and discharge home, defined as sustained blood pressure control <140/90, and the rates of severe hypertension. Thirty-seven women (74%) had their blood pressure well controlled with labetalol monotherapy, 13 (26%) failed to achieve control with labetalol alone, of whom 9 developed severe hypertension. Multivariate logistic regression showed that heart rate, ethnicity and stroke volume index were independent predictors of the response to labetalol. The predictive accuracy of the model was 96% (95% confidence interval (CI) 86–99%). Maternal demographics and haemodynamics are potent predictors for the response to labetalol, and these parameters may guide therapy to enable effective blood pressure control and a lowering of severe hypertension rates.

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Acknowledgements

The study was partly funded by a grant from The King’s College Hospital Charity (Registered Charity 230729). AD acknowledges financial support from the National Institute for Health Research (NIHR) Biomedical Research and from the NIHR Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust.

Author contributions

DS was involved in the planning of the study, collection of data, analysis of the data, and the planning and writing of the manuscript. MB was involved in the collection and analysis of the data, and the preparation of the manuscript. MS was involved in the collection and analysis of the data, and the preparation of the manuscript. DP was involved in the collection and analysis of the data, and the preparation of the manuscript. AD was involved in the planning of the study, the statistical analysis and the preparation of the manuscript. NK was involved in the supervision and planning of the study, analysis of the data, and the planning and writing of the manuscript.

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Authors and Affiliations

  1. Antenatal Hypertension Clinic, King’s College Hospital, London, UK

    D Stott, M Bolten, M Salman, D Paraschiv & N A Kametas

  2. Department of Primary Care and Public Health Sciences and NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust Addison House, King's College London, Guy’s Campus, London, UK

    A Douiri

  3. Harris Birthright Research Centre for Fetal Medicine King’s College Hospital, London, UK

    N A Kametas

Authors
  1. D Stott
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  2. M Bolten
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  3. M Salman
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  4. D Paraschiv
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  5. A Douiri
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  6. N A Kametas
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Corresponding author

Correspondence to N A Kametas.

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The authors declare no conflict of interest.

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Stott, D., Bolten, M., Salman, M. et al. A prediction model for the response to oral labetalol for the treatment of antenatal hypertension. J Hum Hypertens 31, 126–131 (2017). https://doi.org/10.1038/jhh.2016.50

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  • DOI: https://doi.org/10.1038/jhh.2016.50

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