Management of Hypertension in the Early Postpartum: A Randomized Controlled Trial

Objective: Although managing arterial hypertension during pregnancy has been widely discussed, few studies have dealt with the postpartum period. Consequently, the treatment of hypertension in the postpartum generally relies on specialist opinion and guidelines supported by a low level of evidence. We aim to evaluate blood pressure control during the immediate postpartum in hypertensive women who had used methyldopa during pregnancy, comparing continuation of that drug with switching it for captopril. Design and method: A single-blind, randomized clinical trial involving 172 postpartum women with arterial hypertension who had previously used methyldopa during pregnancy at a minimum dose of 750 mg/day for at least one week prior to delivery. Following delivery, the patients were randomized either to continue with methyldopa (minimum dose 250 mg, three times a day) (methyldopa group, n=88) or to switch to captopril at an initial dose of 25 mg, three times a day) (captopril group, n=84). Logistic regression was used to compare the groups regarding the potential to maintain blood pressure below 140/90 mmHg at over 50% of measurements postpartum. Results: In the 48 hours following delivery, no significant differences were found in blood pressure control between the groups (methyldopa 92.0% versus captopril 95.2%), in the incidence of side effects, or postpartum depression (captopril median score 4.0; IQR: 1.0-9.0 versus methyldopa 4.0; 0.0-9.8) (P>0.05). There was no statistically significant difference between the groups with respect to any other clinical endpoint (mean number of hypertensive crises, time until control of blood pressure, need to add other drugs, or maternal and neonatal complications). Conclusions: Continuation of antihypertensive treatment with methyldopa in the postpartum yielded similar results to switching it for captopril, both with regard to the efficacy in controlling blood pressure and the safety of the treatment