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Atenolol vs. Aldomet vs. Labetelol

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Atenolol vs. Aldomet vs. Labetelol

Postby ddchichi » Fri Jan 23, 2004 07:58 am

by ddchichi (6 Posts), Fri Jan 23, 2004 07:58 am

Hello Experts,
Please discuss the risks and benefits of these three drugs for me, and also offer me your advice and/or opinion. My story: My first pregnancy in 1997 @ 25 years I was put on bedrest w/ hbp for 2 weeks, delivered via c-section a healthy 5lb 15 oz girl. BP went back to normal after that, about 1 1/2 years ago my bp went up, couldn't get it down w/ lifestyle and diet, was put on Atenolol, 50mg doing fine, bp is currently averaging about 125/78. So yesterday I went for my 1st obgyn visit, I'm currently 6 weeks. They want me to switch to Aldomet, 2x day because it's a class B drug for pregnancies. Now really to be honest I've heard more PE success stories from ladies on this forum who've been on Atenolol. I know every person's body is different, but I really want to be well educated when I speak to the OB again about this, because my goal is to have an uneventful pregnancy, go to term and have a VBAC. Please advise on this, also I'm working out, taking vitamin C, and eating very healthy, (also thinking about taking baby aspirin, would like more info on it to take to the OB) so I want to what's best. Please advise, thanks for your help.

ddchichi
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Re : Atenolol vs. Aldomet vs. Labetelol

Postby expert on call » Mon Jan 26, 2004 10:15 am

by expert on call (297 Posts), Mon Jan 26, 2004 10:15 am

The issue of treatment with anti-hypertensives is very controversial.

Aldomet is used because it is old and has been studied a bit over time. It is recommended in many texts. It is almost never used in non-pregnant patients.

Labetolol is used because it has some ß-blocker (slowing of heart rate) and some vasodilator properties. As an IV drug in hypertensive crisis, it is very effective. As on oral drug it is not very potent and not commonly used among non-pregnant patients with significant hypertension. It has been used in a relatively large randomized trial of chronic hypertension in pregnancy. There were no complications. There were also no identifiable benefits - largely due to a very low rate of problems in the placebo treated group.

Atenolol is a ß-blocker. It lowers BP by decreasing heart rate and lowering the amount of blood pumped. It has been classified as a class D drug due to one very small study where significant IUGR was observed in 2 patients at very high doses. A very similar drug - metoprolol - is a class C drug. The same side effects would be expected.

In a review of papers about treating hypertension in pregnancy found the following: 1) treatment is associated with a small (approximately 180 grams/10 mm Hg reduction in BP), 2) no drugs were more likely than others to reduce growth. The "standard of appropriate care" is very wide due to a lack of conclusive information. Some experts will not treat until BP is >160/105; others will maintain BP < 130/80.

There is very little data to suggest that vitamin C will help you. It certainly will not hurt you. The large trials of aspirin did not demonstrate much if any effect. Calcium, in women with normal calcium diets, probably does not have much effect.

In our group, we do use atenolol. We have published a small randomized trial demonstrating benefit. We also confirmed the potential to grow smaller babies. We are in a unique position due to our former research to measure cardiac output and adjust dose based on those measurements. When we maintain a normal cardiac output and prevent vasoconstriction with drug adjustments, we avoid many of the problems with reduced growth.

What to do in your case? 50 mg of atenolol is a small dose and unlikely to cause problems with growth. It is working well. This all argues for continuing. Your last baby was 5#15oz. If this was a little early (36 weeks), she was normal sized. If this was at 40 or 41 weeks, she was a bit small. If you had a small baby last time, you carry the risk of a small baby this time.

I hope that this helps.

Expert on Call

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Re : Atenolol vs. Aldomet vs. Labetelol

Postby expert on call » Mon Jan 26, 2004 11:37 am

by expert on call (297 Posts), Mon Jan 26, 2004 11:37 am

This answer has two parts: There are currently different practices among obstetricians, fetal-maternal medicine subspecialists as well as internists who help manage hypertension complicating pregnancy. The preferred drug in the most recent report of the National High Blood Pressure Educational Program’s Working Group is still Methyl-Dopa (Aldomet), based on its many many years of safe use during pregnancy and 7.5 year follow-up data on infants of mothers treated with the drug. There is however, many who utilize alternative drugs, especially Labetalol, claiming suggestive evidence of better fetal out comes when compared to aldomet (the evidence being several systematic reviews of the literature). Concerning atenolol, specifically, there are claims that this class of drugs, especially when used so early in gestation may adversely affect the growth of the fetus. But there are also those who believe the drug may prevent superimposed preeclampsia (a complication that occurs more often in women with essential hypertension). Having said all this, I would side with the use Aldomet here, based mainly on the follow-up data, and the belief that given the different practices, all with the standard of appropriate care, it is best for your physician to use the regimen he or she is most familiar with.

Also, blood pressure normally decreases in early pregnancy, and the decreases in women with essential hypertension can be greater than those observed in normal pregnant women. When these decreases occur spontaneously they often portend a very favorable pregnancy, and if the decrease does not occur the caregiver may be alerted to watch the patients progress even more closely. Thus, there are many who observing a pressure of 125/ 78 mm Hg, might just stop the atenalol and watch, since spontaneous decreases in pressure may continue past the 16th week of pregnancy.

The current status of aspirin or vitamin C prophylaxis to prevent preeclampsia are 1: There may be a very small positive effect of with aspirin but the study of 30,000 patients were needed to reveal this small effect. The trials evaluating the effects of vitamin C have just started. It would seem however that taking a natural vitamin would be innocuous. However, there are rare cases of renal stone disease associated with megadoses of vitamin C. I currently would use neither here believe a healthy for pregnancy diet suffices.

Expert on Call

Information provided on this site is provided for informational purposes only and is not meant to substitute for the advice provided by your own physician or other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disorder, or prescribing any medication. The Preeclampsia Foundation presents all data as is, without any warranty of any kind, express or implied, and is not liable for its accuracy, for mistakes or omissions of any kind, nor for any loss or damage caused by a user's reliance on information obtained on the site. Professional opinions on this condition vary greatly. The Preeclampsia Foundation endorses no one course of treatment or "cure". Responses generated by our Experts to specific questions are based on information anonymously submitted to this site via email, are not based on a complete review of any patient’s medical records and should not be construed as the only reasonable expert response to the info submitted and/or the scenario described.
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Re : Atenolol vs. Aldomet vs. Labetelol

Postby expert@preeclampsia.org » Thu Jul 20, 2006 07:05 pm

by expert@preeclampsia.org (322 Posts), Thu Jul 20, 2006 07:05 pm

Editor Update: please read the updated study results on the use of vitamin/antioxidant supplements during pregnancy here:

http://www.preeclampsia.org/forum/viewtopic.php?t=15819
http://tinyurl.com/yo2c8w

As always, please contact your doctor before adding or discontinuing any medical treatment.
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