PhD defence S.W.A. (Sebastiaan) Nij Bijvank

Below is a brief summary of the dissertation:

This thesis investigates the efficacy and safety of nicardipine for the treatment of severe hypertension during pregnancy. The study was initiated following a randomized trial comparing ketanserin and dihydralazine, which was stopped early because of insufficient efficacy and frequent maternal side effects. Nicardipine appeared to be an effective rescue treatment and was subsequently introduced as a first-line treatment in the participating hospitals.
A review of studies published up to 2009 demonstrated that nicardipine rapidly and effectively reduces blood pressure, with a treatment success rate of 91% and no reported severe maternal or fetal side effects. An updated review including studies up to 2025 confirmed these findings, showing a success rate of 99.2%. Compared with labetalol, nicardipine achieved a greater and faster reduction in blood pressure, without reported severe maternal or fetal adverse effects.
A multicentre retrospective case series involving 830 women further demonstrated that nicardipine was ultimately effective in all patients. Within two hours, 77.4% achieved successful blood pressure control. Temporary hypotension occurred in 42.7% of women but resolved after reducing or discontinuing treatment and generally had no clinical consequences. Only one case of fetal distress was attributed to maternal hypotension.
Pharmacokinetic research showed clinically relevant differences between the two nicardipine enantiomers during pregnancy. Both declined rapidly after dose reduction or discontinuation, and transplacental passage was low. No direct adverse fetal or neonatal effects were observed.
Overall, the findings support nicardipine as an effective and safe first-line treatment for severe hypertension during pregnancy.