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Different effects of tocolytic medication on blood pressure and blood pressure amplification

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Abstract

Background

The importance of tocolysis has been discussed extensively. Beta-2 adrenoceptor agonistic drugs like ritodrine have been the reference tocolytic drugs in most countries. Cardiovascular side-effects are frequent. Atosiban, a newer tocolytic drug, is a competitive antagonist of oxytocin and has fewer cardiovascular side effects. Although large studies exist, there is mainly subjective reporting of adverse reactions with a focus on blood pressure data.

Objectives

Evaluation of the acute effects of therapeutic doses of ritodrine and atosiban in comparison to placebo on central and peripheral blood pressures, central-to-peripheral blood pressure amplification and the augmentation index (AIx) in healthy non-pregnant female volunteers.

Methods

A double-blind, randomized, crossover trial was carried out in 20 healthy non-pregnant female volunteers. Hemodynamic measurements were performed under standardized conditions.

Results

At steady state, central and peripheral pressures did not differ from placebo in the atosiban group. During ritodrine -infusion, central SBP increased by 11% versus placebo (p = 0.012) and peripheral SBP by 10% (p = 0.004). In contrast to atosiban and placebo, blood pressure amplification was absent in the ritodrine group. While the AIx did not change in the atosiban group, with ritodrine, the AIx tended to decrease.

Conclusions

The present study shows the significant effects of ritodrine on the cardiovascular system. Atosiban has no significant effects and may be an appropriate alternative to tocolyticum, particularly in cardiovascularly complicated pregnancies.

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Acknowledgments

The authors would like to thank all included subjects; Mr. Dries Mahieu, Mrs. Tine De Backer, Mrs. Fabienne De Boeck, Mrs. Griet Van Lancker, Mrs. Charline Wehlou, Mr. Marc Twagirumukiza, and Mr. Jan Kips for the blinded medication preparation; and the staff of the Drug Research Unit Ghent for their excellent technical support and know-how.

Trial Number

EudractNr: 2008-000845-76

Author information

Authors and Affiliations

  1. Department of Pharmacology, Heymans Institute, De Pintelaan 185, B-9000, Ghent, Belgium

    Isabelle Fabry, Peter De Paepe, Jan Kips, Sebastian Vermeersch & Luc Van Bortel

  2. Emergency Department, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium

    Peter De Paepe

  3. IBiTech-bioMMeda, Ghent University, De Pintelaan 185, B-9000, Ghent, Belgium

    Jan Kips & Sebastian Vermeersch

Authors
  1. Isabelle Fabry
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  2. Peter De Paepe
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  3. Jan Kips
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  4. Sebastian Vermeersch
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  5. Luc Van Bortel
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Correspondence to Isabelle Fabry.

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Fabry, I., De Paepe, P., Kips, J. et al. Different effects of tocolytic medication on blood pressure and blood pressure amplification. Eur J Clin Pharmacol 67, 11–17 (2011). https://doi.org/10.1007/s00228-010-0926-y

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  • DOI: https://doi.org/10.1007/s00228-010-0926-y

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