Nifedipine as good as labetalol for managing hypertension during pregnancy

Treatment with either nifedipine or labetalol is equally effective in controlling blood pressure (BP) among women with hypertension during pregnancy, with no adverse effects on perinatal outcomes, according to the Giant PANDA* trial presented at SMFM 2026.

The researchers conducted a pragmatic, multicentre, open-label, two-arm randomized controlled trial (RCT) involving 2,254 women (mean age 32 years) with pregnancy hypertension (eg, chronic [41 percent], gestational [46–47 percent], or pre-eclampsia [12–13 percent]) recruited from 57 centres in England and Wales. Participants were randomized in a 1:1 ratio to receive either modified-release nifedipine for 12-hourly dosing or labetalol (n=1,127 in each group).

The study’s co-primary outcomes were severe maternal hypertension, defined as the proportion of days with a healthcare professional measured systolic BP reading ≥160 mm Hg between randomization and birth, and the composite of foetal loss or known neonatal death, or neonatal unit admission.

In the intention-to-treat (ITT) population, a similar rate of severe hypertension was observed in both treatment groups (12 percent [nifedipine] vs 11 percent [labetalol]). [SMFM 2026, abstract LB04]

Similarly, no significant difference in the risk of foetal/neonatal outcome was observed between women treated with nifedipine and those treated with labetalol in the ITT cohort (33 percent vs 31 percent; risk ratio [RR], 1.030) or the per protocol cohort (36 percent vs 33 percent; RR, 1.082).

Birth outcomes, including indicated births, caesarean section rates, gestational age at birth, birthweight, birthweight centile, and the incidence of treated hypoglycaemia, were also not significantly different between the nifedipine and labetalol groups.

Subgroup analyses across hypertension type (chronic, gestational, or pre-eclampsia), diabetes, singleton pregnancy, and gestation demonstrated no significant impact on the co-primary outcomes, said study author Dr Jenny Myers from the University of Manchester, Manchester, England, UK.

However, a notable 3-percent reduction in the number of days with severe hypertension was observed among women of Black ethnicity, where an improvement in BP control favoured nifedipine over labetalol (12 percent vs 15 percent; p<0.01).

With this result, Myers emphasized that “nifedipine is more effective in preventing severe hypertension in Black women.”

Regarding secondary outcomes, the rates of severe maternal morbidity were comparable between the nifedipine and labetalol groups (8 percent for both; RR, 0.99).

However, nifedipine was associated with slightly more episodes of severe hypertension (55 percent vs 46 percent) and new diagnoses of pre-eclampsia (35 percent vs 26 percent), which was due to proteinuria, compared with labetalol.

Discontinuations and clinician-reported side effects were also more frequent in the nifedipine group than in the labetalol group (31 percent vs 17 percent and 55 percent vs 49 percent, respectively), while patient-reported side effects were slightly more common in the labetalol group (39 percent vs 45 percent).

Equally effective antihyperenstive agents

In the context of pregnancy-related hypertension, given the frequent prescription of either nifedipine or labetalol to pregnant women, it is striking that only 204 women have been enrolled in head-to-head RCTs to date, said Myers.

In this first adequately powered trial to evaluate an initial antihypertensive agent, Myers concluded that “nifedipine is as effective as labetalol for treating pregnancy hypertension, with no differences in perinatal outcomes between the two treatments.”