Most agree that
antihypertensive medication should be used to treat severe
hypertension during pregnancy, but its role in patients with mild to moderate disease is debated. None of the regularly used drugs is completely safe for mother and fetus.
Ketanserin decreases systolic and diastolic blood pressure in nonpregnant patients with acute and chronic
hypertension. Its selective
serotonin S2-receptor antagonist activity encouraged investigations into a possible role in pregnant women. These reports can be divided into four groups. Several studies confirmed that intravenous
ketanserin decreases blood pressure significantly in patients with severe
preeclampsia. There are indications that it may be at least as effective as
dihydralazine, possibly with fewer side effects. Its role in chronic
hypertension has not been studied adequately, but one randomized, controlled trial indicated efficacy comparable with that of
alpha-methyldopa. Thirdly, it was concluded in a single descriptive study that the administration of
ketanserin to patients with
HELLP syndrome allowed delivery to be postponed for 5.3 days. Lastly, in a randomized, placebo-controlled trial, the addition of
ketanserin to
aspirin in patients with mild to moderate midtrimester
hypertension was associated with a significant decrease in the number of cases of
preeclampsia and severe
hypertension, as well as a trend to less perinatal mortality, lower rates of
abruptio placentae, and early-onset
preeclampsia. Additional studies are needed to adequately assess a possible role for
ketanserin with acute
hypertension or moderate chronic
hypertension.
TARGET AUDIENCE: After completion of this article, the reader will be able to list the various drugs and their associated side effects that are used to treat hypertensive disorders during pregnancy; to describe the various effects of
serotonin on the cardiovascular system; to summarize the literature concerning the use of
ketanserin during pregnancy; and to list the potential uses of
ketanserin in this setting.