Nicardipine for the Treatment of Severe Hypertension in Pregnancy: An Updated Review

Importance: To reduce morbidity (and mortality) due to severe hypertension in pregnancy by searching the most effective and safe treatment. Objective: Update of our review (2010) on efficacy and safety of intravenous nicardipine for treatment of severe hypertension in pregnancy. Evidence Acquisition: Articles were identified through electronic databases (Medline and Cochrane). Date of search: January 2010 to September 2025. Following search terms were used: pregnancy, severe hypertension, and nicardipine. Included women had chronic or gestational hypertension with or without marked proteinuria. Primary outcomes: reduction of systolic/diastolic and/or mean arterial pressure, time needed to target blood pressure, severe maternal (hypotension, tachycardia), severe fetal (CTG abnormalities needing direct intervention), and side effects. Results: Five studies were added to the original review. Results of 1125 patients were available. All women had a significant reduction of both diastolic and systolic blood pressures. Treatment resulted in a success rate of 99.2%. Time until successful treatment was short with a median of 37 minutes. Comparison of nicardipine versus labetalol showed a significantly greater reduction of blood pressure and a shorter time to success for nicardipine. No severe maternal or fetal side effects were recorded. Conclusions and Relevance: This updated review strengthens our conclusions of 2010: nicardipine is a very effective therapy for the treatment of severe hypertension in pregnancy and may be a better alternative to other available treatment options. More studies are needed to provide safety aspects of nicardipine compared with other agents. Apparently, this is dependent on political choices on the distribution of budgetary scarcity.