Acute Hypertensive Crisis in Pregnancy

Nitric oxide, the endothelium, pregnancy and pre‐eclampsia

“…Wheeler et al 138 found that GTN reduced mean arterial blood pressure, but without altering uterine blood flow, and prevented the expected increase in blood pressure and reduction in uterine blood flow that should have resulted from giving nor adrenaline. There have now been several studies using GTN to treat patients with established proteinuric hypertension 139–141 . Cotton et al 139 showed that GTN reduced mean arterial blood pressure by 25%, and capillary wedge pressure by 30%, without any significant change in heart rate, central arterial pressure or stroke volume in patients with severe pregnancy‐induced hypertension.…”

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

“…Nitric oxide donors have been previously studied in several obstetric complications, including premature labor8–10, prevention of pre‐eclampsia10–12, intrauterine growth restriction13 and hypertensive crisis, and as a maintenance medication14–16. Transdermal GTN is one such nitric oxide donor which reaches stable serum concentrations as early as 2 h after administration7.…”

Inotropic and Vasoactive Agents in the Cardiac Intensive Care Unit

“…75,76 When used parenterally, hydralazine should be started at a low dose (5 mg given as an intravenous bolus every 4 to 6 hours), and increased gradually up to 25 to 30 mg, as tolerated. Although nitroprusside and nitroglycerin are generally preferred as parenteral vasodilators in the acute management of heart failure, there are specific situations in which hydralazine given intravenously may be a useful or necessary alternative.…”