Efficacy of Nitroglycerine Infusion Versus Sublingual Nifedipine in Severe Pre‐eclampsia: A Randomized, Triple‐blind, Controlled Trial

Abstract

1. Information regarding the use of continuous i.v. administration of nitroglycerine as an antihypertensive agent in the management of pre-eclampsia is scarce. In the present study, i.v. nitroglycerine or sublingual nifedipine were administered to 32 women with severe pre-eclampsia who were being managed with controlled plasma volume expansion and MgSO(4) loading and maintenance doses. Maternal blood pressure and heart rate responses, fetal heart rate responses and perinatal fetal-maternal adverse effects were evaluated using classical parametric and non-parametric data analysis and data modelling by mixed models. 2. An important hypotensive response was observed in both groups, although this reponse was greater, faster and exhibited less variability (more precision) in the nitroglycerine-treated group. Heart rate also increased in both the nitroglycerine- and nifedipine-treated groups (4.6 +/- 4.4 vs 8.6 +/- 5.3 b.p.m., respectively), although the increase in the nifedipine-treated group was almost twofold that in the nitroglycerine-treated group. There were no significant changes in fetal heart rate in response to vasodilator therapy. The frequency of perinatal fetal-maternal adverse effects was similar in both groups at 40% and the adverse effects observed included flushing, headache, palpitations and nausea. 3. In conclusion, i.v. infusion of nitroglycerine is an effective, safe and alternative therapy for severe pre-eclampsia.

Transdermal nitroglycerin in patients with severe pre‐eclampsia with placental insufficiency: effect on uterine, umbilical and fetal middle cerebral artery resistance indices

“…GTN caused a significant decrease in the MAP, as the patients were under stable doses of alpha‐methyldopa. Similar results were demonstrated with intravenous20, 32 and transdermal use17. None of the patients had severe hypotension or tachycardia in this study.…”

Hypertension in Pregnancy: Natural History and Treatment Options

“…Its use in women at risk of developing pre-eclampsia was first reported in 1994 where a dose-dependent reduction in uterine artery resistance was demonstrated with intravenous GTN infusion without any effect on maternal cardiovascular parameters [122]. However, further studies have shown a significant reduction in maternal blood pressure without significant adverse events [123,124]. A randomised placebo-controlled trial of low-dose transdermal GTN patches in women with abnormal uterine artery Doppler velocimetry at 24-26 weeks showed that although there was no change in the incidence of preeclampsia, GTN increased the likelihood of a complicationfree pregnancy [125].…”

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

“…Infused nitrogylcerin (vs. oral nifedipine) is comparably effective without adverse effects [335][336][337]. Mini-dose diazoxide (i.e., 15 mg IV every 3 min, vs. parenteral hydralzine) is associated with less persistent severe hypertension [338].…”