Nicardipine: For treatment of severe hypertension in pregnancy

Following the introduction (Chapter 1), we explain the rationale for conducting a doubleblind,
randomized controlled trial comparing ketanserin versus dihydralazine in the
treatment of severe hypertension in early-onset preeclampsia, leading to the adoption
of nicardipine as first-line treatment option (Chapter 2).
Next, we present a review of the literature (Chapter 3), beginning with a 2010 study on
the use of nicardipine for severe hypertension in pregnancy (Chapter 3.1), followed by an
updated review in 2025 (Chapter 3.2).
In Chapter 4, we describe the clinical outcomes of nicardipine use at our hospitals over
more than nine years, presenting the largest cohort on this topic to date.
Chapter 5 presents our pharmacokinetic data of nicardipine in pregnancies complicated
by preeclampsia and severe hypertension. This includes plasma concentrations obtained
through bioanalysis and pharmacokinetic outcomes derived from population pharmacokinetic
modelling and non-compartmental analysis for both enantiomers of racemic nicardipine:
S-nicardipine and R-nicardipine.
Chapter 6 offers a general discussion and reflections on further research.
Finally, Chapter 7 summarizes the key findings of the thesis studies.