Hemodynamic effects of intravenous nicardipine in severely pre-eclamptic women with a hypertensive crisis

Ultrasound Obstet Gynecol. 2016 Jan;47(1):89-95. doi: 10.1002/uog.14836.

Abstract

Objective: Nicardipine permits rapid control of blood pressure in women with severe pre-eclampsia (PE) and hypertensive crisis. Our objective was to investigate its maternal and fetal hemodynamic effects.

Methods: Ten severely pre-eclamptic pregnant women who required intravenous nicardipine for severe hypertension were included in this prospective observational trial. Maternal macrocirculation was assessed by transthoracic echocardiography. Maternal microcirculatory perfusion was examined sublingually with the sidestream dark field imaging technique. Fetal hemodynamics were assessed by Doppler examinations of the uteroplacental and fetal circulations. Maternal cardiac output, total vascular resistance, mitral E/A ratio and capillary heterogeneity index, uterine artery pulsatility index and fetal cerebroplacental ratio were considered primary outcomes. Paired measurements, obtained before administration of nicardipine infusion and after stabilization of blood pressure, were compared.

Results: Administration of nicardipine significantly reduced the mean arterial blood pressure (median difference, 26 mmHg; P = 0.002) and total vascular resistance (median difference, 791 dynes × s/cm(5) ; P = 0.002) in all included women. This induced a reflex tachycardia with consequent increase in cardiac output of 1.55 L/min (P = 0.004). There were no significant changes in the other determinants of maternal or fetal hemodynamic parameters.

Conclusions: Nicardipine effectively reduces blood pressure through selective afterload reduction that triggers an increase in cardiac output, without affecting maternal diastolic function, or microcirculatory, uteroplacental or fetal perfusion. This hemodynamic response is uniform and predictable. Fetomaternal cardiovascular profiling can be achieved by combining transthoracic echocardiography with obstetric Doppler.

Keywords: echocardiography; hemodynamics; hypertensive crisis; nicardipine; pre-eclampsia.

Publication types

  • Observational Study

MeSH terms

  • Administration, Intravenous
  • Adolescent
  • Adult
  • Antihypertensive Agents / therapeutic use*
  • Cardiac Output
  • Echocardiography
  • Echocardiography, Doppler
  • Emergencies*
  • Female
  • Fetus / blood supply*
  • Hemodynamics
  • Humans
  • Hypertension / drug therapy*
  • Microcirculation*
  • Middle Cerebral Artery / diagnostic imaging
  • Nicardipine / therapeutic use*
  • Placental Circulation*
  • Pre-Eclampsia / drug therapy*
  • Pregnancy
  • Prospective Studies
  • Pulmonary Valve Insufficiency / diagnostic imaging
  • Pulsatile Flow
  • Severity of Illness Index
  • Stroke Volume
  • Tricuspid Valve Insufficiency / diagnostic imaging
  • Ultrasonography, Doppler, Color
  • Umbilical Arteries / diagnostic imaging
  • Uterine Artery / diagnostic imaging
  • Vascular Resistance
  • Young Adult

Substances

  • Antihypertensive Agents
  • Nicardipine