To evaluate the efficacy and safety of intravenous nicardipine for the treatment of severe hypertension in pregnancy. Articles were identified through electronic databases (Medline and Cochrane). No date or language restrictions were placed. Relevant citations were hand searched. The following search terms were used: pregnancy, severe hypertension and nicardipine. Patients included had chronic or gestational hypertension with or without marked proteinuria. Primary outcomes were reduction of systolic/diastolic and/or mean arterial pressure, time to target blood pressure, and severe maternal (hypotension, tachycardia) or severe fetal side effects (CTG abnormalities needing direct intervention). Five studies were found describing the use of nicardipine for treatment of severe hypertension in pregnancy. All studies were included in this review. One hundred forty-seven patients were treated. All patients had a significant reduction of both diastolic and systolic blood pressure. Treatment resulted in a 91% success rate in studies that defined success and 20% reduction of mean arterial blood pressure or systolic/diastolic blood pressure in 87%. Target blood pressure was reached within 23 minutes in 70% of the patients, 91% reached target blood pressure within 130 minutes. No severe maternal or fetal side effects were recorded. Nicardipine is a very effective therapy for treatment of severe hypertension in pregnancy and may be a better alternative to other available treatment options.
Target audience: Obstetricians & Gynecologists, Family Physicians.
Learning objectives: After completion of this article, the reader will be able to evaluate the relative effectiveness of nicardipine for the treatment of severe hypertension in pregnancy. Compare the side effect profile of nicardipine to labetolol for the treatment of severe hypertension in pregnancy and calculate the appropriate dosing of nicardipine for the treatment of hypertension in pregnancy.