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. 

Effects of Immediate Postpartum Diuretic Treatment on Postpartum Blood Pressure Among Individuals With Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis

Birthing people with de novo postpartum hypertensive disorders remain among the highest risk for severe maternal morbidity. Randomized controlled trials demonstrate a benefit to oral loop-diuretics in decreasing postpartum hypertensive morbidity in patients with an antenatal diagnosis of preeclampsia. It is not known whether this same therapy benefits patients at risk for new-onset postpartum hypertension OBJECTIVE: To evaluate whether oral furosemide can reduce risk for de novo postpartum hypertension (dnPPHTN) among high-risk birthing people by reducing post-delivery blood pressure.From October 2021 to April 2022, we conducted a randomized triple-masked placebo-controlled clinical trial of individuals at high risk for dnPPHTN at a single university-based tertiary care medical center. A total of 82 postpartum patients with no antenatal diagnosis of chronic hypertension or a hypertensive disorder of pregnancy who were at high-risk for the development of dnPPHTN based on a pre-specified risk factor algorithm were enrolled after childbirth. The participants were randomly assigned in a 1:1 ratio to a five-day course of oral furosemide 20 mg daily or identical-appearing placebo starting within eight hours of delivery. Participants were followed for 6 weeks postpartum using Bluetooth-enabled remote blood pressure monitoring and electronic surveys. The primary outcome was the difference in mean arterial pressure (MAP) averaged over the 24 hours prior to discharge or the 24 hours prior to antihypertensive therapy initiation. The study was powered to detect a 5 mmHg difference in mean MAP (standard deviation 6.4 mmHg) with 90% power at an alpha of 0.05, requiring a sample size of 41 per group. Secondary outcomes included the rate of dnPPHTN, readmission data, other measures of hypertensive and maternal morbidity, breastfeeding data, and drug-related neonatal outcomes.The primary outcome was assessed in 80 of the 82 participants. Baseline characteristics were similar between groups. There was no significant difference in mean MAP 24 hours prior to discharge (or antihypertensive initiation) in the furosemide group (88.9 ± 7.4 mmHg) compared to the placebo group (86.8 ± 7.1 mmHg; absolute difference 2.1 mmHg, 95% CI -1.2 to 5.3). Of the 79 participants for whom secondary outcomes were assessed, 10% (n=8) developed dnPPHTN and 9% (n=7) were initiated on antihypertensive therapy. Rates were not significantly different between groups.De novo postpartum hypertension is a common phenomenon among at-risk patients, warranting close monitoring for severe hypertension and other maternal morbidity. There is insufficient evidence to suggest that furosemide reduces mean MAP in the 24 hours prior to discharge from the delivery hospitalization (or antihypertensive medication initiation) compared to placebo. 

Lasix for the prevention of de novo postpartum hypertension: A randomized placebo-controlled trial (LAPP Trial).

Furosemide for the prevention of de novo postpartum hypertension: A randomized placebo-controlled trial

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Lasix for the prevention of de novo postpartum hypertension: A randomized placebo-controlled trial (LAPP Trial).

Furosemide for the prevention of de novo postpartum hypertension: A randomized placebo-controlled trial