Related Experiment Video
Updated: May 10, 2025
Preterm EEG: A Multimodal Neurophysiological Protocol
Published on: February 18, 2012
Sequence of antihypertensive medications used in preterm infants with hypertension: A cross-sectional study
Alejandro D Perez1, Mary-Carty Pittman1, Kaniz Afroz Tanni2
1Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
Insights
Propranolol is the most common first-line treatment for hypertension in preterm infants. Further research is needed to determine the most effective second-line and adjunctive pharmacologic management strategies.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Pharmacology
Background:
- Hypertension in preterm infants poses significant health risks.
- Limited evidence exists for guiding pharmacologic management of hypertension in this population.
- Population-level data on current clinical practices are lacking.
Purpose of the Study:
- To identify the most prevalent antihypertensive medications used in preterm infants.
- To analyze first-line, second-line, and adjunctive pharmacologic management strategies.
- To establish a baseline for future comparative studies on treatment efficacy and safety.
Main Methods:
- Retrospective, cross-sectional study at a single academic medical center.
- Inclusion criteria: preterm infants (<37 weeks gestation), postnatal age <1 year at discharge, treated for hypertension.
- Bayesian multinomial regression used to estimate prevalence ratios and 95% credible intervals.
Main Results:
- Propranolol was the most prevalent first-line (61%), second-line (40%), and adjunctive (47%) antihypertensive medication.
- First-line propranolol was 4.8 times more prevalent than captopril.
- Data for second-line and adjunctive management prevalence were inconclusive.
Conclusions:
- Propranolol is the predominant first-line pharmacologic agent for hypertension in preterm infants.
- Current data do not conclusively identify the most prevalent second-line or adjunctive treatments.
- This study provides essential data on current prescribing patterns for preterm infant hypertension.
Background:
Hypertension in preterm infants can result in life-threatening outcomes. However, there is limited evidence to guide the pharmacologic management of hypertension in preterm infants. Without population-level studies of the pharmacologic strategies that clinicians currently employ for hypertension in preterm infants, studies investigating the benefits and risks of these strategies cannot be performed.
Methods:
A retrospective, cross-sectional study was conducted at a single academic medical centerto determine the most prevalent antihypertensive medication used for first-line, second-line, and adjunctive pharmacologic management among preterm infants with hypertension. The study sample included patients with a postnatal age less than 1 year at hospital discharge, gestational age at birth less than 37 weeks, and treated with an antihypertensive medication between July 2010 and December 2022. The prevalence of each antihypertensive medication used for each stage of pharmacologic management was estimated, and prevalences were compared using prevalence ratios. Bayesian multinomial regression was used to estimate prevalence ratios and 95% credible intervals (CIs).
Results:
Out of 751 possibly eligible patient encounters obtained, 134 encounters were identified across 120 patients that met the inclusion criteria. Second-line and adjunctive pharmacologic management were used in 6 and 12 encounters, respectively. Propranolol had the highest prevalence for each stage of pharmacologic management: 61% for first-line (95% CI: 53-69%); 40% for second-line (95% CI: 14-70%); and 47% for adjunctive pharmacologic management (95% CI: 24-72%). As a first-line pharmacologic management, propranolol was 4.8 times (95% CI: 2.9-7.7) as prevalent as the second most prevalent medication (captopril).
Conclusion:
In a large academic hospital, propranolol was the most commonly used medication for first-line antihypertensive pharmacologic management among preterm infants. The most prevalent medication used for second-line and adjunctive pharmacologic management was inconclusive.
More Related Videos
Related Concept Videos
01:31Adrenergic Antagonists: ɑ and β-Receptor Blockers
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:23Antihypertensive Drugs: Vasodilators
01:18Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme...
01:16Antihypertensive Drugs: Action of Diuretics
01:25Antihypertensive Drugs: Direct Renin Inhibitors