Torsemide for Prevention of Persistent Postpartum Hypertension in Women With Preeclampsia

Abstract

OBJECTIVE: To evaluate whether torsemide reduces the rate of persistent postpartum hypertension in women with preeclampsia. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of women with preeclampsia at a tertiary center from August 2016 to September 2017. Those with gestational hypertension or renal or cardiopulmonary failure were excluded. Within 24 hours of delivery, women were randomized one to one to oral torsemide, 20 mg/d, or placebo, for 5 days. Our primary outcome was blood pressure greater than or equal to 150 mm Hg systolic or 100 mm Hg diastolic (or both) on two occasions at least 4 hours apart by postpartum day 5 or by the time of hospital discharge. Assuming a 50% rate of persistent hypertension in women with preeclampsia, 118 participants were required to detect a 50% rate reduction. Analyses were by intention to treat. RESULTS: From August 2016 to September 2017, 118 women were randomized: 59 were allocated to torsemide and 59 to placebo. Overall, 43 (73%) women in the torsemide and 45 (76%) in the placebo group had either preeclampsia with severe features or preeclampsia superimposed on chronic hypertension. The rate of persistent postpartum hypertension was 44% in the torsemide and 58% in the placebo group (relative risk 0.76, 95% CI 0.5–1.1). No differences were seen in rate of hypertension 7–10 days or 6 weeks postpartum, severe hypertension, length of postpartum hospital stay, readmission for hypertension, or adverse events. There were no cases of severe composite morbidity or deaths. CONCLUSION: In this trial of women with preeclampsia, a 5-day course of postpartum torsemide did not have a significant effect on the rate of postpartum hypertension. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02813551.

Updates in Management of Hypertensive Disorders of Pregnancy

“…High dose Methylprednisolone was not found to be effective to prevent drop of platelets count in preeclamptic patient with count 150.000 unit/cc or keep it above 100.000 unit/ cc [41]. 5-day postpartum course of Torsemide was not found to be effective in prevention of persistent postpartum preeclampsia [42].…”

Best Practices for Managing Postpartum Hypertension

“…Among patients with antenatal HDP, who have a known risk of worsening hypertension in the postpartum period, effective therapies for risk reduction have been an area of ongoing research. Several studies have found that administration of diuretics postpartum can reduce the prevalence of postpartum hypertension among patients with antenatal HDP [ 35 , 36 •, 37 ]. In particular, among patients with antenatal HDP who received a 5-day course of 20 mg furosemide daily, there was a 60% reduction in the prevalence of persistently elevated blood pressure at 7 days, though no difference in postpartum readmissions or need for antihypertensive medications compared to patients who received placebo [ 36 •].…”

Preeklamsia Pascasalin

“…Hasil penelitian tersebut menunjukkan bahwa tidak terdapat perbedaan terhadap tingkat hipertensi 7-10 hari atau 6 minggu pascasalin, lama rawat inap pascasalin, perawatan ulang untuk hipertensi, dan efek samping. 19 Selain penggunaan medikamentosa untuk pencegahan preeklamsia pascasalin, modifikasi gaya hidup juga bermanfaat untuk mencegah penyakit kronik seperti penyakit kardiovaskuler. 20…”