Grand Rounds

Does Ibuprofen Increase the Risk for Postpartum Hypertension in the Setting of Preeclampsia?

BACKGROUND AND PURPOSE:

NSAIDS have been associated with increased blood pressure in healthy nonpregnant women and may antagonize the effects of antihypertensive medications, leading to the possibility that their use may also increase risk in women with preeclampsia or gestational hypertension
In women with postpartum hypertension, it has been recommended that these drugs should be avoided, based on limited evidence
Blue et al. (AJOG, 2018) assessed whether ibuprofen adversely affects postpartum blood pressure control in women with preeclampsia with severe features

Double-blinded randomized study
Participants: Women with preeclampsia with severe features
Women were randomized to received either
- 600 mg ibuprofen every 6 hours
- 650 mg acetaminophen every 6 hours
Dosing began within 6 hours after delivery and continued to discharge
Opioid analgesics were available in case of breakthrough pain
Primary outcome
- Duration of severe-range hypertension
- Defined as the time (in hours) from delivery to the last blood pressure ≥160/110 mm Hg
Secondary outcomes:
- Time from delivery to last blood pressure ≥150/100 mm Hg
- Mean arterial pressure
- Need for antihypertensive medication at discharge
- Prolongation of hospital stay for blood pressure control
- Postpartum use of short-acting antihypertensives for acute blood pressure control
- Opioid use for breakthrough pain
Data was analyzed according to intention-to-treat principles

Data was collected from 100 eligible women
93 completed the study in their assigned groups
No differences were found between the group in baseline characteristics
No difference was found in the primary outcome measure
- Duration of severe-range hypertension in the ibuprofen group (35.3 hours) vs acetaminophen groups (38.0 hours); P=.30
No differences were found in secondary outcomes
In a subgroup analysis of patients who experienced severe-range hypertension, the mean time to blood pressure control was also not significantly different
- Acetaminophen group (68.4 hours) and ibuprofen group (56.7 hours); P = .26
At 6 weeks postpartum, there were no differences between groups in the rates of obstetric triage visits, hospital readmissions, continued opioid use, or continued antihypertensive use

The substitution of acetaminophen for ibuprofen did not impact the duration of severe-range hypertension in women with preeclampsia with severe features
Future studies needed to
- Determine differences in rare outcomes
- Assessment of NSAID use in preeclampsia without severe features

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