2-3THE EFFECT OF IBUPROFEN VS ACETAMINOPHEN ON POSTPARTUM BLOOD PRESSURE IN WOMAN WITH HYPERTENSIVE DISORDER OF PREGNANCY: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIAL

Abstract

Introduction: The American College of Obstetricians and Gynecologists (ACOG) suggested replacing NSAIDs with other analgesics for pain relief management of hypertension in pregnancy because of the risk of elevating blood pressure. However, the evidence to support this issue remains unclear. This systematic review aims to investigate the risk of elevated postpartum blood pressure for the woman with hypertensive disorders of pregnancy treated with ibuprofen compared to acetaminophen. Methods: We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines during our literature search. Pubmed, EBSCOhost, and Proquest were used for database searching up to December 2019. We included studies with the following criteria: English article, human study; randomized controlled trial; relevant patient characteristics; and outcome assessment. Two authors independently assessed the quality of the included study using Cochrane Risk of Bias Tool 2.0 covering six domains with scores of “low,” “high,” “unclear.” Results: We identified a total of 79 studies from search strategies. We found four studies that have a relevant issue. One study has an unclear risk of selection bias. Another study has a high risk of performance bias. Moreover, all studies suggested having an unclear risk of detection bias. All studies are randomized controlled trials with a total of 345 participants treated with ibuprofen or acetaminophen. Evaluation for a difference of mean arterial pressure after treatment showed insignificant difference between study groups. Other studies reported measurement with a mean maximum of systolic and diastolic blood pressure and also revealed an insignificant difference between group. Only 1 study suggesting the risk of using ibuprofen for elevating blood pressure which resulted from a significant difference between study group comparing number of patients having blood pressure ≥ 150/100 mmHg after treatment. Conclusion: Despite limited studies, we concluded that most studies showed insignificant difference between the use of NSAIDs particularly ibuprofen, compared with other analgesic such as acetaminophen for the risk of elevating blood pressure in woman with hypertensive disorder of pregnancy. Further studies with more extensive trials were necessary to elucidate better quality of evidence.