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#Grand Rounds

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

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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

METHODS:

  • 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

RESULTS:

  • 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

CONCLUSION:

  • 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

Learn More – Primary Sources:

Effect of ibuprofen vs acetaminophen on postpartum hypertension in preeclampsia with severe features: a double-masked, randomized controlled trial

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone

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Related ObG Topics:

Are NSAIDs Associated with Persistent Postpartum Hypertension in Women with Preeclampsia?
Do Non-Opioids Work as Well as Opioids for Acute Extremity Pain? 
How Well Does IV Acetaminophen Control Post-Op Cesarean Pain?

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