Celastrol synergizes with oral nifedipine to attenuate hypertension in preeclampsia: a randomized, placebo-controlled, and double blinded trial

Preeclampsia, a disease mainly manifesting as serious hypertension during pregnancy, affects expectant mothers around the globe. Celastrol, a naturally existing triterpenoid, is known to exhibit beneficial effects attenuating cardiovascular symptoms including hypertension. We here assessed the treatment outcome against preeclampsia with a combined use of celastrol and nifedipine. A total of 626 patients with preeclampsia were enrolled, screened, and assigned by random to groups receiving either nifedipine + placebo or nifedipine + celastrol orally. Time required to control hypertension as well as time before another hypertensive crisis were defined as primary end points. Secondary end points include the number of dosages required to control hypertension, as well as maternal and neonatal adverse effects. The time to control hypertension showed a marked reduction in nifedipine + celastrol group, while time before a new hypertensive crisis was significantly lengthened with the treatment, compared with the nifedipine + placebo group. The number of dosages required to control hypertension was also lower in the nifedipine + celastrol group. The two treatment groups were not statistically different regarding adverse effects, either maternal or neonatal. Results from the current study provide evidence for the potential role of celastrol serving as an effective and safe adjuvant to oral nifedipine against hypertension in patients with preeclampsia.