Chandrasekaran Sandhya, Azzi Marly, Potchileev Sanela, Patel Easha, Bisson Courtney, Mueller Ariel, Duncan Colleen, Rana Sarosh
Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Chicago Medical Center, Chicago, IL, USA.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
Pregnancy Hypertens. 2025 Mar;39:101199. doi: 10.1016/j.preghy.2025.101199. Epub 2025 Jan 29.
Oral furosemide postpartum improves the time to hypertension resolution in randomized control trials. Further investigation is needed to determine the impact of furosemide in routine clinical practice.
Real world study to assess impact of furosemide on rates of postpartum hypertension and readmissions for patients with hypertensive disorders of pregnancy.
A prospective cohort study of postpartum patients with hypertensive disorders of pregnancy at a single institution between October 2021 and April 2022. Patients were enrolled in the remote postpartum blood pressure monitoring program (RPM) as standard of care. Use of oral furosemide for 5 days postpartum was implemented per protocol for all patients with gestational hypertension and preeclampsia. Data was obtained until six weeks postpartum. Exclusion criteria included age less than 18 years old, patients with chronic hypertension alone without superimposed preeclampsia, and patients who did not provide consent for data collection. The primary outcome was hospital readmission within six weeks postpartum. The secondary outcome was blood pressure values across those six weeks. Hypertension was defined as any blood pressure value with SBP ≥ 140 mmHg or DBP ≥ 90 mmHg.
Overall, 545 patients were enrolled in the RPM program during the study period, 306 of them consented to data collection and 258 patients were ultimately included after meeting all inclusion criteria with no exclusions. Of these, 203 patients received furosemide. Overall, 47.7 % of patients had gestational hypertension, 40.3 % of patients had preeclampsia with or without severe features, and 12.0 % of patients had superimposed preeclampsia with or without severe features. In total, 24.2 % of patients were discharged home on an antihypertensive medication in addition to furosemide. The overall rate of readmission was 13.2 %. There was no difference between patients who received oral furosemide versus those who did not (12.8 % vs 14.6 %, p = 0.74). Rates of hypertension at the one-week postpartum visit between those two groups did not differ significantly (32.8 % [oral furosemide] vs 36.2 % [no furosemide], p = 0.66). Diastolic blood pressures at the six-week follow-up visit were lower in the furosemide group (74 [69,81] vs 82 [76,89]; p = 0.02) among patients registered to care who completed the six-week visit.
The addition of furosemide did not result in improved blood pressure control by the first week postpartum or fewer hospital readmissions. However, diastolic blood pressure trended lower at the six-week visit in patients who received furosemide.
在随机对照试验中，产后口服速尿可缩短高血压缓解时间。需要进一步研究以确定速尿在常规临床实践中的影响。
进行一项真实世界研究，以评估速尿对妊娠高血压疾病患者产后高血压发生率和再入院率的影响。
对2021年10月至2022年4月期间在单一机构就诊的产后妊娠高血压疾病患者进行一项前瞻性队列研究。患者作为标准治疗被纳入远程产后血压监测项目（RPM）。按照方案，对所有妊娠高血压和先兆子痫患者在产后5天使用口服速尿。收集数据至产后六周。排除标准包括年龄小于18岁、单纯慢性高血压无叠加先兆子痫的患者以及未同意收集数据的患者。主要结局是产后六周内再次入院。次要结局是这六周内的血压值。高血压定义为收缩压≥140 mmHg或舒张压≥90 mmHg的任何血压值。
总体而言，在研究期间有545名患者被纳入RPM项目，其中306名同意收集数据，258名患者在满足所有纳入标准且无排除后最终被纳入。其中，203名患者接受了速尿治疗。总体而言，47.7%的患者患有妊娠高血压，40.3%的患者患有伴有或不伴有严重特征的先兆子痫，12.0%的患者患有伴有或不伴有严重特征的叠加先兆子痫。共有24.2%的患者除速尿外还带着降压药出院回家。再入院的总体发生率为13.2%。接受口服速尿的患者与未接受速尿的患者之间没有差异（12.8%对14.6%，p = 0.74）。两组在产后一周就诊时的高血压发生率没有显著差异（32.8%[口服速尿]对36.2%[未用速尿]，p = 0.66）。在完成六周随访的登记护理患者中，速尿组在六周随访时的舒张压较低（74[69,81]对82[76,89]；p = 0.02）。
加用速尿并未在产后第一周改善血压控制或减少再次入院情况。然而，接受速尿治疗的患者在六周随访时舒张压有下降趋势。
