Nifedipine for severe hypertension in pregnancy: emotion or evidence?

A meta-analysis of randomized controlled trials suggests that nifedipine appears to be a reasonable agent for treatment of acute severe hypertension in pregnancy. However, in a 1999 survey of Canadian practitioners, most stated that they rarely or never use nifedipine capsules for treatment of acute severe pregnancy hypertension. Also, there are case reports of adverse outcomes following use of nifedipine capsules in pregnancy, although the risks appear to have been overplayed. We suggest that a reasonable approach is ongoing use of nifedipine capsules, with perhaps an initial dosage of 5 mg rather than 10 mg. Having women swallow the capsule without first biting it may also be a prudent approach, because there is insufficient information from most of the published clinical trials to say exactly how the nifedipine capsules were administered. Further, use of the 10 mg nifedipine prolonged action tablet may also be a reasonable approach for treatment of severe hypertension in pregnancy, although more data are needed. Such research would be particularly relevant given that nifedipine appears to be a promising treatment for spontaneous preterm labour. We must resist the temptation to throw out of our limited therapeutic armamentarium an effective oral preparation before adequately considering the evidence.