The Optimal Treatment of Severe Hypertension in Pregnancy: Update of the Role of Nicardipine

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.