Hypertensive disorders are a primary contributor to peripartum morbidity and mortality during pregnancy. Pregnant women of low socioeconomic status can be 10-30 times more hypertensive than normal women.  Such Unfavorable consequences are more prevalent in women exhibiting target organ damage, uncontrolled severe hypertension, and noncompliance with prenatal visits [1]. Pregnancy-related hypertension,  especially when diastolic pressure in the first trimester of pregnancy is ≥110 mm Hg , is linked with a higher risk of both short- and long-term adverse outcomes for the mother like abruptio placentae or superimposed preeclampsia, [2] and the fetus (higher chance of perinatal morbidity and mortality) [3]. Failure of HTN treatment can cause placental abruption, eclampsia, HELLP syndrome, pulmonary edema, and even death [4,5]. For non-pregnant patients with a BP= ≥140/90 mm Hg require antihypertensive is the standard of care; however, treatment during pregnancy is debatable (Angras et al., 2022; Braunthal & Brateanu, 2019). HTN in men and non-pregnant women is frequently categorized as mild, moderate, severe, or very severe based on the SBP or diastolic BP [4,6]. While chronic HTN in pregnancy is classified as mild or severe diastolic BP = ≥ 110 mm Hg (Korotkoff phase V) [7,8]. Type of pre-eclampsia known as Superimposed preeclampsia includes exacerbation of HTN, edema, proteinuria, hyperuricemia, or a combination of these symptoms [9].

Antihypertensive treatment of pregnant women during mild chronic <160/110 mm Hg, and chronic HTN to target <140/90 mm Hg would reduce the chance of unfavorable pregnancy outcomes rather than a control strategy of no antihypertensive treatment unless the SBP = 160 mm Hg or higher or the diastolic pressure was 105 mm Hg or higher. Women who received no anti-hypertensive treatment suffered a risk of being underweight for gestational age, medically indicated preterm birth at less than 35 weeks gestation, placental abruption, or fetal or neonatal death. The significance of antihypertensive therapy in women may be further clarified by research on the long-term effects on women and their fetus like on cardiovascular and other body organs.  Hydralazine [10] has long been the primary prescribed antihypertensive for severe HTN in pregnancy with associated deteriorating pre-eclampsia symptoms like headache, nausea, and vomiting [11].

Parenteral hydralazine proved more effective inducing maternal hypotension [1]. However, Labetalol demonstrates a comparative efficacy due to 7times more selectivity for β-blockade than α blockade [3]. However, women with mild chronic or chronic HTN can better select the antihypertensive medication for them [12] however, during the first trimester, only 1.9% of women received antihypertensive therapy [13]. Labetalol is rarely used by women to treat hypertension outside of pregnancy, it is significant for those who are actively trying to conceive.  because embryogenesis begins during the first trimester of pregnancy, which can last up to 13 weeks of gestation, it is imperative to assess every possible risk [14,15] resulting from the theoretical implications of drug-induced teratogenicity during this critical time. There exists a critical demand for randomized RCT. Because findings of RCT will facilitate the identification of a pharmaceutical intervention anticipated to yield superior outcomes in safeguarding women from potentially life-threatening complications [1,16].

The current study aims to compare the effectiveness of two anti-hypertensive medications, labetalol and hydralazine in the treatment of severe hypertension during pregnancy, by readily achieving desired BP [17,18].