The effect of nitroglycerin infusion versus hydralazine infusionas antihypertensive therapy in acute management of patientswith severe pre-eclampsia

Background Severe pre-eclampsia (PE) is a potentially life-threatening multisystem disease that requires urgent management. Delivery of the fetus is the definitive treatment for PE. However, effective and safe control of severe hypertension is the most important aspect of critical care management. This study aimed to compare the effectiveness and safety profile of hydralazine infusion versus nitroglycerin infusion as antihypertensive therapy in the acute management of patients with severe PE.Patients and methodsA total of 180 patients with severe PE admitted to Ain Shams Obstetric ICU to stabilize blood pressure before delivery were randomly assigned to one of two equal groups: group H and group N. Group H received hydralazine infusion (1 mg/ml) and group N received nitroglycerin infusion (1 mg/ml). The infusion rate (5 ml/h) was adjusted to maintain systolic blood pressure at 130–140 mmHg and diastolic blood pressure at 80–100 mmHg.ResultsAs regards hemodynamic parameters, the time to achieve blood pressure control was significantly shorter in the N group compared with the H group. However, the number of cases of severe persistent hypertension and the number of attacks of hypotension were comparable between the two groups. Maternal side effects and fetal and neonatal complications were comparable between the two groups, except for maternal headache and tachycardia, which were significantly higher in the H group compared with the N group. Concerning the mode of delivery, the rate of cesarean section delivery was significantly higher than the rate of vaginal delivery in both groups. Meanwhile, the rate of cesarean section after induction of labor was significantly higher in the N group compared with the H group.Conclusion Nitroglycerin could be a good alternative option for the acute management of patients with severe PE. It is an effective antihypertensive with minimal side effects.