Hypertensive disorders of pregnancy (HDP) are a worldwide concern for pregnant women and are one of the leading causes of maternal death. In China, the incidence is 94%～10.4%, the second leading cause of maternal death. A systolic blood pressure of 160 mmHg and/or diastolic blood pressure of 110 mmHg is referred to as a severe hypertensive disorder of pregnancy, i.e., a hypertensive crisis state, and is at high risk of developing comorbidities such as cardiovascular disease and pulmonary edema. If not active**, serious complications such as placental abruption, fetal death, intrauterine death, and maternal death may occur, which seriously affects the health of mothers and babies [1].
In patients with HDP, blood pressure lowering should be performed rapidly without affecting the hemodynamic changes of the placenta in pregnant women. How to safely and effectively ** hypertensive disorders during pregnancy is a major challenge for doctors. How to choose HDP** drugs?
Nicardipine is a third-generation dihydropyridine calcium ion antagonist, which is widely used in the control of acute severe hypertension and postoperative blood pressure. Compared with other calcium antagonists, nicardipine is more selective for vascular smooth muscle (the ratio of selectivity for vascular smooth muscle to myocardium is 30 000 1), so it has a significantly less inhibitory effect on the heart and is less likely to cause reflex tachycardia than nifedipine [2]. At present, nicardipine has been widely used in patients with severe gestational hypertension and has become an ideal antihypertensive drug for patients with severe gestational hypertension.
Compared with labetalol, nicardipine has the best effect in severe gestational hypertension and has a promoting effect on the improvement of blood pressure levels.
In a randomized controlled study, 120 patients with severe gestational hypertension were included [3]. The experimental group was injected with intravenous nicardipine, and after 24 hours after the blood pressure was stabilized, oral nicardipine sustained-release capsules were administered orally for **5 days. The control group was injected with labetalol intravenously, and after 24 hours after the blood pressure was stabilized, labetalol tablets were taken orally for 5 consecutive days.
The results are displayed. 1. Difference in blood pressure level: After 5 consecutive days, the study group was lower than the control group (p< 005）。Nicardipine is a dihydropyridine calcium ion antagonist, which has a blocking effect on calcium ion channels on peripheral arterial vascular smooth muscle cells, which can prevent calcium ions from flowing inward, so as to suppress smooth muscle excitation, dilate peripheral arterioles, and reduce peripheral vascular resistance, so as to give full play to the antihypertensive effect.
2. Differences in pregnancy outcomes: In terms of the incidence of adverse pregnancy outcomes, the study group was lower than the control group ( p< 005）。Nicardipine is a calcium antagonist drug, which can inhibit the excitability of uterine smooth muscle after use, so as to achieve the effect of contractile coupling, relaxation of uterine smooth muscle and alleviation of intrauterine hypoxia in the fetus, and finally achieve the purpose of lowering blood pressure and improving pregnancy outcomes.
Hanff et al.4 compared 27 patients with early-onset preeclampsia (34 weeks' gestation) who did not respond to ketanserin, dihydralazine, or labetalol to an intravenous infusion rate of 3 g at the beginning of nicardipine, and found that the blood pressure of all patients was controlled within 23 minutes on average, and the pregnancy period was prolonged by an average of 47. There were no obvious adverse reactions in pregnant women and fetuses. Nicardipine may be a potential option in patients with severe, early-onset preeclampsia who have failed to respond to other antihypertensive medications**.
Nicardipine hydrochloride injection.
There are many patients with hypertensive crisis during pregnancy, and actively searching for reasonable and effective drugs is of great value to improve pregnancy outcomes and reduce maternal and infant mortality. Nicardipine has the clinical characteristics of immediate onset, stable blood pressure reduction, and effective protection of target organs, and has good effects in blood pressure, tolerance, and prolongation of gestational age, which is of great significance for improving pregnancy outcomes.
References: 1] Sun Xuezhu. **Effect of magnesium sulfate combined with labetalol**gestational hypertensive disorders-severe preeclampsia[J].China Health Care and Nutrition, 2019, 29(33): 251
2] nij bijvank sw，duvekot jj. nicardipine for the treatment of severe hypertension in pregnancy ：a review of the literature［ j ］.obstet gynecol surv，2010，65（5）：341 - 347.
3] Xie Xiaomin. Clinical efficacy of nicardipine and labetalol** in severe gestational hypertension[J].Smart Health[2023-11-27].
4]hanff lm，vu lto ag，barte ls pa，et al n tr**enous use of the calci-um channel blocker nicard ipine as second-line trea tm ent in severeearly-onset pre-ec lam ptic patien ts[j]. j h ypertens2005,23( 12):2319-2326.