Am J Perinatol 2009; 26(7): 495-499
DOI: 10.1055/s-0029-1214251
© Thieme Medical Publishers

Acute Antihypertensive Therapy in Pregnancy-Induced Hypertension: Is Nicardipine the Answer?

Rakesh B. Vadhera1 , Luis D. Pacheco1 , 2 , 3 , Gary D.V Hankins2
  • 1Department of Anesthesiology, The University of Texas Medical Branch at Galveston, Galveston, Texas
  • 2Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
  • 3Division of Maternal Fetal Medicine, Division of Surgical Critical Care, The University of Texas Medical Branch at Galveston, Galveston, Texas
Further Information

Publication History

Publication Date:
24 April 2009 (online)

ABSTRACT

Hypertensive disorders in pregnancy constitute one of the most frequent medical complications during gestation. Unfortunately, maternal and perinatal mortality remains significant worldwide in this population. Not infrequently, patients with severe preeclampsia will need parenteral agents to achieve rapid blood pressure control to avoid end-organ damage. During the last decades, new antihypertensive medications have become available for management of hypertensive crisis. One of these agents is the calcium channel blocker nicardipine. Nicardipine has been used extensively in different clinical settings including neurosurgery, cardiothoracic surgery, transplant medicine, and internal medicine patients. Minimal data exist in the literature regarding the use of this medicine during pregnancy. The purpose of this article is to review the pharmacological properties of nicardipine, the available literature regarding its use during pregnancy, and potential interactions with other medicines used commonly in preeclampsia, as well as potential side effects directly affecting the peripartum period.

REFERENCES

  • 1 Duley L. Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean.  Br J Obstet Gynaecol. 1992;  99 547-553
  • 2 Marik P E, Varon J. Hypertensive crises: challenges and management.  Chest. 2007;  131 1949-1962
  • 3 The Fifth Report of the Joint National Committee on Detection . Evaluation, and treatment of high blood pressure (JNC V).  Arch Intern Med. 1993;  153 154-183
  • 4 Sibai B M. Treatment of hypertension in pregnant women.  N Engl J Med. 1996;  335 257-265
  • 5 Lipshitz J, Ahokas R A, Reynolds S L. The effect of hydralazine on placental perfusion in the spontaneously hypertensive rat.  Am J Obstet Gynecol. 1987;  156 356-359
  • 6 Martin Jr J N, Thigpen B D, Moore R C, Rose C H, Cushman J, May W. Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure.  Obstet Gynecol. 2005;  105 246-254
  • 7 Duley L, Henderson-Smart D J, Meher S. Drugs for treatment of very high blood pressure during pregnancy.  Cochrane Database Syst Rev. 2006;  3 CD001449
  • 8 Lunell N O, Lewander R, Nylund L, Sarby B, Thornstrom S. Acute effect of dihydralazine on uteroplacental blood flow in hypertension during pregnancy.  Gynecol Obstet Invest. 1983;  16 274-282
  • 9 Vink G J, Moodley J. The effect of low-dose dihydralazine on the fetus in the emergency treatment of hypertension in pregnancy.  S Afr Med J. 1982;  62 475-477
  • 10 Lindheimer M D, Katz A I. Hypertension in pregnancy.  N Engl J Med. 1985;  313 675-680
  • 11 Davey D, Adommisse J, Garden A. Intravenous labetalol and intravenous dihydralazine in severe hypertension in pregnancy. In: Riley A, Symonds EM The Investigation of Labetalol in the Management of Hypertension in Pregnancy: Proceedings of a Symposium at the Royal College of Physicians. Amsterdam; Excerpta Medica 1982: 51-61
  • 12 Shepherd A M, Ludden T M, McNay J L, Lin M S. Hydralazine kinetics after single and repeated oral doses.  Clin Pharmacol Ther. 1980;  28 804-811
  • 13 Mabie W C, Gonzalez A R, Sibai B M, Amon E. A comparative trial of labetalol and hydralazine in the acute management of severe hypertension complicating pregnancy.  Obstet Gynecol. 1987;  70 328-333
  • 14 Hall V A, Guest J M. Sodium nitroprusside induced cyanide intoxication and prevention with sodium thiosulphate prophylaxis.  Am J Crit Care. 1992;  1 19-27
  • 15 Vidaeff A C, Carroll M A, Ramin S M. Acute hypertensive emergencies in pregnancy.  Crit Care Med. 2005;  33 S307-S312
  • 16 Lindow S W, Davies N, Davey D A, Smith J A. The effect of sublingual nifedipine on uteroplacental blood flow in hypertensive pregnancy.  Br J Obstet Gynaecol. 1988;  95 1276-1281
  • 17 Hanretty K P, Whittle M J, Howie C A, Rubin P C. Effect of nifedipine on Doppler flow velocity waveforms in severe pre-eclampsia.  BMJ. 1989;  299 1205-1206
  • 18 Moretti M M, Fairlie F M, Akl S, Khoury A D, Sibai B M. The effect of nifedipine therapy on fetal and placental Doppler waveforms in preeclampsia remote from term.  Am J Obstet Gynecol. 1990;  163 1844-1848
  • 19 Bennett P, Edwards D. Use of magnesium sulphate in obstetrics.  Lancet. 1997;  350 1491
  • 20 Von Dadelszen P, Magee L A. Antihypertensive medications in management of gestational hypertension-preeclampsia.  Clin Obstet Gynecol. 2005;  48 441-459
  • 21 Wallin J D, Cook M E, Blanski L et al.. Intravenous nicardipine for the treatment of severe hypertension.  Am J Med. 1988;  85 331-338
  • 22 Vidaeff A C, Carroll M A, Ramin S M. Acute hypertensive emergencies in pregnancy.  Crit Care Med. 2005;  33 S307-S312
  • 23 Varon J, Marik P E. The diagnosis and management of hypertensive crises.  Chest. 2000;  118 214-227
  • 24 Aya A G, Mangin R, Hoffet M, Eledjam J J. Intravenous nicardipine for severe hypertension in preeclampsia—effects of an acute treatment on mother and fetus.  Intensive Care Med. 1999;  25 1277-1281
  • 25 Carbonne B, Jannet D, Touboul C, Khelifati Y, Milliez J. Nicardipine treatment of hypertension during pregnancy.  Obstet Gynecol. 1993;  81 908-914
  • 26 Elatrous S, Nouira S, Ouanes L et al.. Short term treatment of severe hypertension of pregnancy: prospective comparison of nicardipine and labetalol.  Intensive Care Med. 2002;  28 1281-1286
  • 27 Hanff L M, Vulto A G, Bartels P A et al.. Intravenous use of the calcium channel blocker nicardipine as second line treatment in severe, early onset preeclamptic patients.  J Hypertens. 2005;  23 2319-2326
  • 28 Ducsay C A, Thompson J S, Wu A T, Novy M J. Effects of calcium entry blocker (Nicardipine) tocolysis in rhesus macaques: fetal plasma concentrations and cardiorespiratory changes.  Am J Obstet Gynecol. 1987;  157 1482-1486
  • 29 Parisi V M, Salinas J, Stockmar E J. Placental vascular responses to nicardipine in the hypertensive ewe.  Am J Obstet Gynecol. 1989;  161 1039-1043
  • 30 Parisi V M, Salinas J, Stockmar E. Fetal vascular response to maternal nicardipine administration in the hypertensive ewe.  Am J Obstet Gynecol. 1989;  161 1035-1039
  • 31 Holbrook Jr J H, Voss E M, Gibson R N. Ovine fetal cardiorespiratory response to nicardipine.  Am J Obstet Gynecol. 1989;  161 718-721
  • 32 Aya A G, Bruelle P, Lefrant J Y, Saissi G, Ferrer J M, Eledjham J J. Accidental nicardipine overdosage without serious maternal or neonatal consequence.  Anaesth Intensive Care. 1996;  24 99-101
  • 33 Jannet D, Abankwa A, Guyard B, Carbonne B, Marpeau L, Milliez J. Nicardipine versus salbutamol in the treatment of premature labor. A prospective randomized study.  Eur J Obstet Gynecol Reprod Biol. 1997;  73 11-16
  • 34 Jannet D, Carbonne B, Sebban E, Milliez J. Nicardipine versus metoprolol in the treatment of hypertension during pregnancy: a randomized comparative trial.  Obstet Gynecol. 1994;  84 354-359
  • 35 Kobayashi A, Mizobe T, Tojo H, Hashimoto S. Autonomic hyperreflexia during labour.  Can J Anaesth. 1995;  42 1134-1136

Rakesh B VadheraM.B.B.S. F.R.C.A. F.F.A.R.C.S.I. 

Department of Anesthesiology, The University of Texas Medical Branch at Galveston

301 University Boulevard, Galveston, TX 77555-0591

Email: rbvadher@utmb.edu

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