Work

Long-term cardiovascular risks in patients with hypertensive disorders of pregnancy treated with nifedipine or labetalol

Year: 2026

Type: article

Abstract: Background: Hypertensive disorders of pregnancy (HDP) are established precursors to future cardiovascular disease. Current guidelines endorse labetalol, nifedipine, and methyldopa as first-line antihypertensive therapies, but data on long-term maternal cardiovascular risk are limited. Objectives: We evaluated five-year postpartum outcomes of HDP patients who were exposed to nifedipine or labetalol during pregnancy. Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Network. Patients were identified using ICD-10-CM codes for HDP-excluding those with pre-existing hypertension-and categorized by treatment with labetalol or nifedipine. Patients exposed to amlodipine or methyldopa were excluded. After 1:1 propensity score matching, we compared cardiovascular and renal outcomes over five years. Results are reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI) and as hazard ratios (HR) from Kaplan-Meier survival analysis. Results: After matching, 11,764 patients remained in each cohort (23,528 total). Nifedipine exposure was associated with lower odds of chronic hypertension (CH, aOR 0.835, 95% CI [0.778, 0.896], p < 0.001), heart failure (HF, aOR 0.699, 95% CI [0.527, 0.926], p = 0.012), HF with reduced ejection fraction (HFrEF, aOR 0.608, 95% CI [0.418, 0.886], p = 0.009), and chronic kidney disease (CKD, aOR 0.653, 95% CI [0.492, 0.867], p = 0.003) compared to labetalol. Time-to-event analysis confirmed these findings. Conclusion: Among HDP patients, nifedipine exposure during the index pregnancy was associated with lower five-year risks of CH, HF, HFrEF, and CKD compared with labetalol. These findings suggest that antihypertensive choice in pregnancy may differentially affect long-term maternal cardiovascular health.

Source: International Journal of Cardiology Cardiovascular Risk and Prevention

DOI: 10.1016/j.ijcrp.2026.200649