Management of hypertension in the early postpartum: A randomized controlled trial

Abstract

Objectives: To evaluate blood pressure control during the immediate postpartum period in hypertensive women who had used methyldopa during pregnancy, comparing continuation of that drug with switching it for captopril.

Study design: A single-blind, randomized clinical trial involving 172 postpartum women with hypertension who had previously used methyldopa during pregnancy at a minimum dose of 750 mg/day for at least one week prior to delivery. The subtypes of hypertension included were gestational hypertension, chronic hypertension, preeclampsia, superimposed preeclampsia, HELLP syndrome and eclampsia. Following delivery, the patients were randomized either to continue with methyldopa at a minimum dose of 250 mg, three times a day (methyldopa group, n = 88) or to switch to captopril at an initial dose of 25 mg, three times a day (captopril group, n = 84).

Main outcome measures: Logistic regression was used to compare the groups regarding the potential to maintain blood pressure below 140/90 mmHg at over 50 % of measurements postpartum.

Results: In the 48 h following delivery, no significant differences were found between the groups regarding blood pressure control (methyldopa 92.0% versus captopril 95.2%), side effects, postpartum depression (Edinburgh Postnatal Depression Scale) or other clinical outcomes (hypertensive peaks, time to blood pressure control, additional medication use, or maternal and neonatal complications).

Conclusion: Continuation of antihypertensive treatment with methyldopa in the postpartum period yielded similar results to switching it for captopril, both with regard to the efficacy in controlling blood pressure and the safety of the treatment.

Keywords: Captopril; Hypertension; Methyldopa; Postpartum period; Pregnancy-induced.