USE OF ANTIHYPERTENSIVE AGENTS IN THE MANAGEMENT OF HYPERTENSIVE CRISES IN PREGNANCY: A NARRATIVE REVIEW OF THE LITERATURE

Abstract

Introduction: Hypertensive crises during pregnancy are high-risk obstetric emergencies associated with severe complications such as eclampsia, stroke, and fetal impairment. Rapid and safe management depends on the selection of effective antihypertensive agents; however, the literature shows heterogeneity and a scarcity of robust trials, which hinders the definition of an ideal therapeutic approach. Objectives: To elucidate and structure recent evidence on the use of antihypertensives in hypertensive crises during pregnancy, highlighting the efficacy, tolerability, and safety of the main pharmacological options. Methods: A narrative review was conducted based on clinical guidelines, systematic reviews, randomized clinical trials, and observational studies addressing the immediate treatment of severe gestational hypertension. The analysis focused on the most commonly used medications and their clinical effects. Results: Hydralazine, labetalol, and nifedipine are the most frequently used drugs. Hydralazine shows established efficacy but is associated with a higher incidence of maternal adverse effects. Labetalol demonstrates similar efficacy with better tolerability and is widely recommended in international protocols. Nifedipine stands out for its oral administration, rapid action, and lower frequency of adverse events, making it a practical alternative in various clinical settings. Agents such as nitroprusside and nicardipine appear only as rescue options due to limited data and potential maternal–fetal risks. Conclusions: Evidence indicates similar efficacy among hydralazine, labetalol, and nifedipine in the management of hypertensive crises during pregnancy, with variation primarily in tolerability. Significant gaps remain in the literature, reinforcing the need for more robust studies to standardize therapeutic recommendations.