Does immediate postpartum diuretic treatment reduce postpartum blood pressure and persistent hypertension in individuals with hypertensive disorders of pregnancy?
Immediate postpartum diuretic use in individuals with hypertensive disorders of pregnancy modestly reduces systolic blood pressure but does not significantly decrease the rate of persistent hypertension or the need for additional antihypertensive therapy.
BACKGROUND: Hypertensive disorders of pregnancy are associated with ongoing postpartum hypertension and increased morbidity. Extravascular water and sodium mobilization are implicated in postpartum blood pressure (BP) elevation; however, trials of postpartum diuretics in hypertensive disorders of pregnancy have had mixed results. Our meta-analysis aimed to analyze the impact of postpartum diuretics on postpartum hypertension following hypertensive disorders of pregnancy. METHODS: A systematic review was performed to identify observational cohort studies and randomized controlled trials studying the efficacy of diuretics in the treatment of postpartum BP. Meta-analysis outcomes included persistent hypertension up to 10 days postpartum, mean postpartum systolic and diastolic BPs, and use of additional antihypertensive medications. RESULTS: From 10 included randomized controlled trials and 1 prospective cohort study with a moderate level of bias, 1624 subjects were included in the meta-analysis. Postpartum diuretic use was associated with lower systolic BP (SMD, -0.44 95% CI, -0.66 to -0.21) without a difference in diastolic BP (SMD, -0.15 95% CI, -0.47 to 0.16) compared with controls. There was no difference in rates of persistent hypertension between the postpartum diuretics group versus controls (odds ratio, 0.69 95% CI, 0.44-1.08) or in antihypertensive medication use (odds ratio, 0.68 95% CI, 0.46-1.03). There was significant heterogeneity in the diuretic effect on outcomes. CONCLUSIONS: Postpartum diuretic use was associated with no difference in persistent hypertension, diastolic BP, or need for hypertensive therapy. A modest reduction in systolic BP was observed, though of uncertain clinical significance. Larger, high-quality studies are needed to clarify whether postpartum diuretic use may be of clinical benefit.
Keen et al. (Tue,) studied this question.
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