The Optimal Treatment of Severe Hypertension in Pregnancy: Update of the Role of Nicardipine
Linda S. Nooij, Sanne Visser, Tess Meuleman, Paul Vos, Robin Roelofs and Christianne J.M. de Groot
Affiliation: Department of Obstetrics and Gynecology, VUMC, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands.
Keywords: Ketanserin, labetalol, nicardipine, pre-eclampsia, pregnancy induced hypertension, treatment.
Objective: Hypertensive disorders in pregnancy remain a major cause of maternal morbidity and mortality.
Blood pressure control is essential for maternal and neonatal outcome. Therefore, we analyzed the potency and side effects
of two treatment options (nicardipine compared to labetalol) in order to gain insight in improved treatment of severe
hypertension during pregnancy and to evaluate the feasibility of a randomised controlled trial. Study design: A nested case
control study in an inner city teaching hospital alongside a meta-analysis. Data from women who received nicardipine
were compared with patients who received labetalol during pregnancy. Primary outcome measure was successful control
of severe hypertension. Secondary outcome measures were maternal and neonatal side effects. These results were included
in a meta-analysis. Results: Only one previous study described nicardipine in comparison to labetalol during pregnancy.
The combined results indicate a similar success-rate of treatment with nicardipine compared to labetalol during
pregnancy. Women treated with nicardipine had more often tachycardia, headache and nausea compared to women treated
with labetalol. Hypotension resulting in fetal distress was found more often in the labetalol group. Conclusion: Nicardipine
is a potent drug to control hypertension during pregnancy with side effects including maternal headaches, nausea and
tachycardia. Labetalol had more neonatal side effects including hypotension compared with nicardipine. These results
support the justification and prove that it is safe to perform a randomized controlled trial comparing nicardipine to labetalol
in the treatment of severe hypertension in pregnancy.
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