ABSTRACT
Severe hypertension remains a critical threat in the management of pre-eclampsia, particularly in
low-resource settings where it significantly contributes to maternal and neonatal morbidity and
mortality. Hydralazine, a direct-acting vasodilator, remains widely used due to its affordability and
accessibility. However, concerns persist about its safety, delayed onset, and potential maternal and
neonatal side effects, including reflex tachycardia, headaches, and risks to the foetus. This study
assessed the clinical effectiveness and safety of intravenous hydralazine in women with severe
pre-eclampsia in a tertiary hospital in Nigeria. It focused on blood pressure control, dosage needs,
and associated maternal and neonatal outcomes. A cross-sectional observational study was
conducted among 38 women with severe hypertension (SBP ≥160 mmHg or DBP ≥110 mmHg)
beyond 28 weeks of gestation. Each received intravenous Hydralazine. Primary outcomes included
time to achieve target blood pressure (<160/110 mmHg), number of doses required, and adverse
effects. Data were analysed using SPSS version 23. Hydralazine was effective in 97.4% of cases
(37/38), with a median time of 60 minutes (IQR: 40–80) to achieve blood pressure control. A
median of three doses (IQR: 2–4) was required. No hypotension was observed. Maternal side
effects included tachycardia (26.3%) and headache (18.4%). Neonatal outcomes were concerning,
with three early neonatal deaths (7.9%), suggesting possible foetal compromise despite effective
maternal blood pressure control. In conclusion, intravenous Hydralazine remains a viable option
for managing severe hypertension in pre-eclampsia where resources are limited. However, its
delayed action and potential adverse effects—especially on neonates—highlight the need for
cautious use, close monitoring, and further comparative research to enhance treatment safety and
efficacy.
Keywords: Hydralazine, Severe Hypertension, Pre-eclampsia, Cross-Sectional Study, Efficacy,
Safety, Neonatal Outcomes, Nigeria.
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