Keen Susan K, Sall Koura, Koczo Agnes, Wang Yisi, Miller Rebekah S, Muldoon Matthew F, Hauspurg Alisse K, Countouris Malamo E
Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Internal Medicine, Temple University, Philadelphia, Pennsylvania, USA.
medRxiv. 2025 Jan 5:2025.01.03.25319983. doi: 10.1101/2025.01.03.25319983.
Hypertensive disorders of pregnancy (HDP) are associated with ongoing postpartum hypertension (HTN) and increased morbidity. Extravascular water and sodium mobilization is implicated in postpartum blood pressure (BP) elevation, however trials of postpartum diuretics in HDP have had mixed results. Our meta-analysis aimed to analyze the impact of postpartum diuretics on postpartum hypertension following HDP.
Systematic review identified randomized controlled trials (RCTs) studying the efficacy of diuretics in the treatment of postpartum BP. Meta-analysis outcomes included persistent HTN up to 10 days postpartum, mean postpartum systolic and diastolic BPs, and use of additional antihypertensive medications.
From 9 RCTs, 1273 subjects were included in the meta-analysis. Postpartum diuretic use was associated with lower systolic BP (SMD standard mean difference]: -0.36; 95% confidence interval [CI]: -0.72; -0.01) without a difference in diastolic BP (SMD: 0.01; 95% CI: -0.22; 0.23) compared with controls. There was no difference in rates of persistent HTN between the postpartum diuretics group versus controls (OR: 0.70; 95% CI: 0.4; 1.05) or in antihypertensive medication use (OR: 0.66; 95% CI: 0.42; 1.05).
Postpartum diuretic use was associated with lower systolic BP compared with controls and non-significant trends of lower rates of persistent HTN and postpartum antihypertensive medication use. Due to the low certainty of evidence, uniform postpartum diuretic use with HDP cannot be recommended. Future studies are needed to evaluate specific HDP subgroups who may benefit from diuretic use.
妊娠期高血压疾病（HDP）与产后持续性高血压（HTN）及发病率增加有关。血管外水和钠的动员与产后血压（BP）升高有关，然而，HDP产后利尿剂试验的结果不一。我们的荟萃分析旨在分析产后利尿剂对HDP后产后高血压的影响。
系统评价确定了研究利尿剂治疗产后血压疗效的随机对照试验（RCT）。荟萃分析结果包括产后10天内的持续性HTN、产后平均收缩压和舒张压以及额外降压药物的使用。
从9项RCT中，1273名受试者纳入荟萃分析。与对照组相比，产后使用利尿剂与较低的收缩压相关（标准化均数差[SMD]：-0.36；95%置信区间[CI]：-0.72；-0.01），而舒张压无差异（SMD：0.01；95%CI：-0.22；0.23）。产后利尿剂组与对照组之间持续性HTN的发生率（OR：0.70；95%CI：0.4；1.05）或降压药物的使用（OR：0.66；95%CI：0.42；1.05）没有差异。
与对照组相比，产后使用利尿剂与较低的收缩压相关，持续性HTN和产后降压药物使用率较低的趋势不显著。由于证据的确定性较低，不建议对HDP统一使用产后利尿剂。需要进一步的研究来评估可能从利尿剂使用中获益的特定HDP亚组。
