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Oral Concurrent Session 5 - Hypertension

Oral Concurrent Sessions

Oral Concurrent Session 5 - Hypertension

(61) Postpartum Diuretics for Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis

Friday, January 31, 2025
2:30 PM – 2:45 PM  
Location: Aurora Ballroom B, Lobby Level
Objective: To systematically review postpartum use of diuretics to reduce persistent hypertension (HTN) among individuals with hypertensive disorders of pregnancy (HDP).

Study Design: A systematic review was conducted in MEDLINE, OVID, Scopus, World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials from inception to 4/2024 (PROSPERO CRD42021288277). Randomized controlled trials (RCTs) investigating postpartum use of diuretics in individuals with HDP were included. Clinical characteristics and outcome measures were extracted. The primary outcome was persistent HTN postpartum. Secondary postpartum outcomes were use of additional antihypertensive drugs, length of stay, readmission/emergency visits, and breastfeeding. Meta-analysis was performed using a random effects model to estimate treatment effects in terms of risk ratios (RR) or mean difference with 95% confidence interval (CI).

Results: Of 571 studies reviewed, eight RCTs with 1368 individuals (767 intervention, 771 control) met inclusion criteria. Interventions included furosemide (3 RCTs), torsemide (1 RCT), combined furosemide/antihypertensive drug (3 RCTs), and combined thiazide/angiotensin-converting enzyme inhibitor (1 RCT). There was a significant reduction in persistent HTN between intervention and control groups (4 RCTs, N=955, RR 0.53, 95%CI 0.35-0.80, I2=70%, Figure 1). The number needed to treat (NNT) to reduce persistent HTN was 4. There was no difference in the need for additional antihypertensives during admission (7 RCTs, N=1209, RR 0.79, 95%CI 0.61-1.02, I2=7%) or at the time of discharge (5 RCTs, N=905, RR 1.00 95%CI 0.82-1.21, I2=53%). There was no difference in length of stay, readmission/emergency visits, or breastfeeding between groups.

Conclusion: Diuretics were associated with a reduction in persistent HTN postpartum in individuals with HDP (NNT=4). Heterogeneity in study interventions and outcomes suggests that the optimal postpartum dosing and timing of diuretics in HDP warrants further study.