Comparison of oral enalapril-hydrochlorothiazide and oral nifedipine in treating postpartum hypertension: an open label randomized controlled trial.
Raveena Bhagat, Sangam Jha, Supriya Subhi
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In 30 seconds
This open-label randomized controlled trial compared oral nifedipine with enalapril-hydrochlorothiazide in women with postpartum hypertension, from delivery through 6 weeks postpartum. Sustained blood pressure control for at least 48 hours was similar between groups (63.75% vs 72.2%; P=.242). The combination produced lower post-treatment mean systolic and diastolic pressures and fewer participants required additional antihypertensive medication (28.7% vs 14.4%; P=.02). Time to target blood pressure and reported adverse effects were comparable, and no maternal complications were observed.
Key findings
- Sustained control for 48 hours did not differ significantly: 63.75% with nifedipine versus 72.2% with enalapril-hydrochlorothiazide (P=.242).
- Post-treatment mean SBP was 138.3±11.69 vs 133.0±11.31 mmHg (mean difference, -5.3 mmHg; P=.003), and mean DBP was 88.0±7.66 vs 84.8±9.14 mmHg (mean difference, -3.2 mmHg; P=.02).
- Additional antihypertensive medication was required more often with nifedipine than with combination therapy (28.7% vs 14.4%; P=.02).
- Time to target blood pressure was comparable (3.65±1.77 vs 3.76±1.6 hours; P=.101); adverse effects were mild and comparable.
Why it matters
Postpartum hypertension carries short- and long-term cardiovascular risk, while evidence on oral treatment choices remains limited. These findings suggest that enalapril-hydrochlorothiazide may achieve greater blood pressure reduction and reduce the need for additional medication, although the trial did not show a significant difference in its primary sustained-control outcome.
What to keep in mind
The trial was open-label and conducted at a single tertiary care institute, which may limit generalisability.