Effects of Immediate Postpartum Diuretic Treatment on Postpartum Blood Pressure Among Individuals With Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: 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.
Source: Hypertension
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Building Interdisciplinary Research Careers in Women's Health in Pittsburgh, Development of a smartphone-based device to detect fluid overload among postpartum women with hypertensive disorders of pregnancy, Postpartum low-dose aspirin to augment vascular recovery following a hypertensive disorder of pregnancy, Building Interdisciplinary Research Careers in Women's Health in Pittsburgh, Training Program in Imaging Sciences in Translational Cardiovascular Research
OpenAlex ID: W4416107573