Background: Severe maternal hypertension is linked to adverse perinatal outcomes. Both nifedipine and hydralazine are commonly used antihypertensive agents in this setting. Methods: A comprehensive literature search was conducted in PubMed, Cochrane Library, and EMBASE from inception to April 2024 to identify randomized controlled trials comparing oral or sublingual nifedipine with intravenous hydralazine for the management of severe hypertension, with or without preeclampsia/eclampsia. A random-effects meta-analysis was performed using RevMan. Results: Seven randomized controlled trials were included. The pooled analysis demonstrated no significant difference between the two agents regarding time to achieve optimal blood pressure control (MD = −1.08 min, 95% CI = −6.66 to 4.49), caesarean delivery (OR = 0.62, 95% CI = 0.38 to 1.03), neonatal birth weight (MD = 57.65 g, 95% CI = −209.09 to −324.40), NICU admissions (OR = 0.90, 95% CI = 0.41 to 1.98), and 5-min APGAR scores (MD = 0.1, 95% CI = −0.20 to 0.39). However, patients receiving nifedipine had significantly lower odds of experiencing medication-related adverse events (OR = 0.62, 95% CI = 0.40 to 0.97). Conclusions: Nifedipine and intravenous hydralazine showed comparable efficacy in achieving optimal blood pressure control and similar maternal and neonatal outcomes. However, nifedipine was associated with significantly fewer maternal adverse effects, indicating superior tolerability.

A 60-year-old woman with hypertension and a family history of aneurysms was found to have an incidental basilar tip aneurysm following a fall at Alicante airport. She had no history of polycystic kidney disease and was a non-smoker. The aneurysm measuring 1.2 cm was discovered following imaging after the head injury. The patient was counselled about treatment options, including endovascular embolization, which she opted for after understanding the cumulative risk of rupture. The procedure was performed via right common femoral artery (CFA) and left superficial femoral (SF) access under ultrasound guidance. Stents (2.25mm Leo Baby, Debene S.A., Buenos Aires, Argentina) were placed in both posterior cerebral arteries (PCAs), followed by subarachnoid (SA) coiling of the aneurysm. Post-procedure angiography confirmed no residual aneurysm filling, patent branches, and no thrombus formation. Postoperatively, the patient developed bilateral vision loss and intermittent confusion. Neurological examination, including cranial nerve and ophthalmology assessment, was unremarkable except for anterograde amnesia. Arterial blood gas (ABG) analysis ruled out metabolic causes, and inflammatory markers and septic screening were unremarkable. Repeat MRI with diffusion-weighted imaging (DWI) sequences showed no acute infarction. Supportive management, including intravenous fluids, antithrombotic therapy, and symptomatic relief, was initiated. The patient’s vision improved from perception of light (PL) to hand motion (HM) bilaterally and fully recovered within 48 hours. This case highlights transient cortical blindness as a possible complication following cerebral angiography. The primary differential was posterior reversible encephalopathy syndrome (PRES), but the absence of other symptoms such as headache, aphasia, facial numbness, seizures, ataxia, or visual hallucinations made transient cortical blindness the more likely etiology.