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CME Credit Offered
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Poster Session 2

(584) Outcomes among patients in a remote postpartum blood pressure monitoring program: does medication choice matter?

Thursday, January 30, 2025
4:00 PM – 6:00 PM  

    Submitting Author and Presenting Author(s)

  • Ntami P. Echeng, MD (she/her/hers)

    Resident
    Women & Infants Hospital of Rhode Island / Alpert Medical School of Brown University
    Providence, RI, United States

    • Coauthor(s)

  • Shana D. Talbot, MD

    Resident
    Women & Infants Hospital of Rhode Island / Alpert Medical School of Brown University
    Providence, Rhode Island, United States

  • SM

    Scott Machado, MPH

    Women & Infants Hospital of Rhode Island / Alpert Medical School of Brown University.
    Providence, Rhode Island, United States

  • TJ

    Tracy L. Jackson, PhD

    Women & Infants Hospital of Rhode Island / Alpert Medical School of Brown University.
    Providence, Rhode Island, United States

  • NK

    Nicole Konecke

    Women & Infants Hospital of Rhode Island / Alpert Medical School of Brown University.
    Providence, Rhode Island, United States

  • WH

    William Hunt

    Women & Infants Hospital of Rhode Island / Alpert Medical School of Brown University.
    Providence, Rhode Island, United States

  • DS

    Danielle Simmons, FNP

    Women & Infants Hospital of Rhode Island / Alpert Medical School of Brown University.
    Providence, Rhode Island, United States

  • MM

    Maria Mejia Castillo, CHW

    Women & Infants Hospital of Rhode Island / Alpert Medical School of Brown University.
    Providence, Rhode Island, United States

  • William A. Grobman, MBA, MD

    Professor
    The Ohio State University
    Columbus, Ohio, United States

  • Alisse Hauspurg, MD (she/her/hers)

    Assistant Professor
    Alpert Medical School of Brown University
    Providence, RI, United States

  • Methodius G. Tuuli, MBA, MD, MPH

    Professor and Chair
    Women & Infants Hospital of Rhode Island / Alpert Medical School of Brown University
    Providence, Rhode Island, United States

  • Adam K. Lewkowitz, MD, MPH

    Assistant Professor
    Women & Infants Hospital of Rhode Island / Alpert Medical School of Brown University.
    Providence, Rhode Island, United States

Objective: Participants in postpartum self-measured blood pressure (SMBP) programs can have antihypertension medications initiated remotely, thereby preventing severe hypertension (HTN) and reducing HTN-related readmissions, emergency department (ED) presentations, and severe maternal morbidity (SMM). Nifedipine and labetalol are commonly prescribed first-line HTN medications, although outcomes related to their use may differ.  We aimed to compare outcomes between participants in a postpartum remote SMBP program who were prescribed nifedipine versus labetalol after hospital discharge.

Study Design: Postpartum patients with HTN at our tertiary care hospital are offered enrollment in our remote 6-week SMBP program, during which antihypertensives are prescribed for BP >140/90 mmHg. For this analysis, participants were stratified by antihypertensive prescribed (nifedipine versus labetalol). Patients who were prescribed a different medication or who were prescribed both medications were excluded. The primary outcome was a composite of postpartum readmission or ED presentation for HTN within 30 days of delivery hospitalization. Secondary outcomes included HTN-related SMM.  A generalized linear model was used to estimate relative risks (RR) after adjustment for differences in medical conditions.

Results: Among 2003 remote SMBP participants, 446 (22.3%) were prescribed either labetalol alone (n=104; 23%) or nifedipine alone (n=342; 77%) after hospital discharge. Differences between groups were identified in type of HTN diagnosis (Table 1). After controlling for these differences, the rate of the composite outcome of HTN-related postpartum readmission or ED presentation was similar between those who received labetalol (n=23 (22.1%)) or nifedipine (n=65 (19.1%); adjusted relative risk =1.26 (0.81, 1.94) (Table 2). There were no differences between groups for secondary outcomes.

Conclusion: In our remote SMBP program for postpartum patients with HTN, there was no difference in risk of HTN-related healthcare utilization between those prescribed labetalol alone or nifedipine alone for persistent HTN after hospital discharge.