From the Guidelines
Nitroglycerin is the organic nitrate commonly used as an antihypertensive in obstetric patients, particularly in cases of pre-eclampsia or eclampsia associated with pulmonary oedema, as recommended by the 2024 ESC guidelines 1.
Key Points
- Nitroglycerin is given as an i.v. infusion in pre-eclampsia or eclampsia associated with pulmonary oedema.
- The use of nitroglycerin in this context is based on the latest guidelines from the European Society of Cardiology, emphasizing its role in managing severe hypertension in pregnancy 1.
- It's essential to note that while hydralazine is often discussed in the context of hypertension management in pregnancy, the most recent and highest quality evidence points towards the use of nitroglycerin in specific scenarios, such as pulmonary oedema 1.
Mechanism and Safety
- Nitroglycerin works by relaxing vascular smooth muscle, leading to vasodilation and a subsequent decrease in blood pressure.
- Its use must be carefully monitored due to potential side effects, including headache and hypotension.
- Despite these considerations, nitroglycerin is valued for its effectiveness in critical situations, such as severe hypertension complicated by pulmonary oedema in pregnant patients 1.
Clinical Considerations
- The management of hypertension in pregnancy requires careful consideration of both maternal and fetal well-being.
- Guidelines recommend a multidisciplinary approach, involving obstetricians and other specialists, to ensure the best outcomes for both mother and baby 1.
- The choice of antihypertensive agent should be based on the most current evidence and guidelines, taking into account the specific clinical scenario and the potential risks and benefits of each medication.
From the FDA Drug Label
The organic nitrates are vasodilators, active on both arteries and veins. The answer is nitroglycerin, as it is an organic nitrate that can be used as an antihypertensive in obstetric patients 2.
From the Research
Antihypertensive Agents in Obstetric Patients
- The use of antihypertensive agents in obstetric patients is crucial for managing severe pre-eclampsia and hypertensive crises 3.
- Various studies have investigated the efficacy and safety of different antihypertensive agents, including nitroglycerine, nifedipine, labetalol, hydralazine, and methyldopa 4, 3, 5, 6, 7.
Organic Nitrates as Antihypertensive Agents
- Nitroglycerine is an organic nitrate that has been used as an antihypertensive agent in obstetric patients 4.
- A study published in 2008 found that intravenous nitroglycerine was effective in reducing blood pressure in women with severe pre-eclampsia, with a faster and more precise response compared to sublingual nifedipine 4.
- Another study mentioned the use of glyceryl trinitrate, an organic nitrate, as an intravenous anti-hypertensive agent in the management of severe pre-eclampsia 3.
Comparison with Other Antihypertensive Agents
- Nifedipine, a calcium channel blocker, has been compared to hydralazine and found to be more effective in controlling blood pressure in severe pre-eclampsia 5, 6.
- Labetalol, another antihypertensive agent, has been used as a first-line treatment for severe hypertension in pregnancy, but its effectiveness compared to nifedipine and hydralazine is still being studied 6, 7.
- Methyldopa is also used as an antihypertensive agent, but its usage is less common compared to labetalol, nifedipine, and hydralazine 7.