90: A randomized controlled trial of ibuprofen on postpartum blood pressure in hypertensive disorders of pregnancy

Abstract

Nonsteroidal antiinflammatory drugs, such as ibuprofen, are common and effective analgesics in the postpartum period, but there is concern over the potential for these medications to increase blood pressure in women with hypertensive disorders of pregnancy. Our aim was to evaluate the effect of ibuprofen on blood pressure in this hypertensive population during the immediate postpartum period. In this double-blind randomized control trial, women with new diagnoses of hypertensive disorders of pregnancy without severe-range blood pressures were randomly assigned to receive a mild analgesic regimen consisting of either ibuprofen or acetaminophen, with additional medications administered as needed to achieve pain control. The primary outcome was average mean arterial pressure during postpartum hospital admission. Secondary outcomes included average mean arterial blood pressure by postpartum day, pain control, length of hospital stay, achievement of postpartum diuresis, and patient satisfaction. Sixty-one women with hypertensive disorders were randomized and completed the trial. There was no difference in average mean arterial pressure during the postpartum hospital admission (92.7 for those in the ibuprofen group versus 92.8 in the control group without nonsteroidal medication exposure, p=0.93, Table), nor was there a difference in trend of mean arterial pressure by postpartum day (p=0.25). We found no differences between groups in the secondary outcomes for pain control or length of hospital stay. There was no difference between groups for proportion of patients who met criteria for postpartum diuresis (61.3% in ibuprofen group versus 76.7% in the control group, p=0.20; Cox regression HR 0.72 [95% CI 0.39-1.32, p=0.29], Figure). A high level of satisfaction was reported, with 89.7% in the ibuprofen group and 73.3% in the control group reporting pain was "always" well controlled during hospital stay (p=0.21). In women with mild hypertensive disorders of pregnancy, no increase in postpartum blood pressure was noted in those who received ibuprofen versus those who were not exposed to nonsteroidal antiinflammatory medications for postpartum analgesia.View Large Image Figure ViewerDownload Hi-res image Download (PPT)