Hydrochlorothiazide–lisinopril combo bests nifedipine for BP control in postpartum hypertension

In women with postpartum hypertension, treatment with combined hydrochlorothiazide (HCTZ)/lisinopril yields greater blood pressure (BP)-lowering benefit than nifedipine monotherapy, according to the results of a pilot study.

The study included 70 women with chronic hypertension or hypertensive disorder of pregnancy, defined as having two measurements of systolic BP ≥150 mm Hg and/or diastolic BP ≥ 100 mm Hg within 72 hours after delivery. They were randomly assigned to receive either HCTZ/lisinopril or nifedipine.

The primary endpoint was stage 2 hypertension (systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg) using a home BP monitor on days 7–10 after delivery or readmission to the hospital for BP control. The secondary endpoints included severe maternal morbidity (intensive care unit admission, HELLP syndrome, eclampsia, stroke, cardiomyopathy, or maternal death), intravenous medication after randomization, hospital length of stay, BP during first clinic visit, medication compliance, and adverse events.

Of the participants, 31 received HCTZ/lisinopril, 36 received nifedipine, and three withdrew consent after randomization. Data on the primary outcome was unavailable for nine participants. Stage 2 hypertension was documented in 27 percent of participants in the HCTZ/lisinopril group and in 43 percent in the nifedipine group (posterior adjusted relative risk, 0.74, 95 percent credible interval, 0.40–1.31).

On Bayesian analysis, HCTZ/lisinopril was associated with an 85-percent posterior probability of reduced risk of stage 2 hypertension when compared with nifedipine.

Secondary outcomes and adverse events were similar in the two treatment groups.

More studies are needed to confirm the findings.