REVIEW   

Minerva Obstetrics and Gynecology 2022 August;74(4):348-55

DOI: 10.23736/S2724-606X.21.04733-3

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Clinical management of hypertensive disorders in postpartum women

Maria SCUDO, Luciano PETRUZZIELLO, Fabiana CARBONE ✉, Alessandra LOGOTETA, Giulia PAONI SACCONE, Ottavia D’ORIA, Paola GALOPPI, Roberto BRUNELLI, Marco MONTI

Department of Maternal and Child Health and Urological Sciences, Umberto I Policlinic Hospital, Sapienza University, Rome, Italy

Hypertensive disorders of pregnancy (HDP) could persist post-partum, or appear for the first time after delivery and could require a pharmacological treatment. It was found no evidence in literature about which therapy should be used in puerperal hypertension. The aim of this review is to determine the most effective therapy and best in terms of risk-benefit ratio for the treatment of high postpartum systemic arterial blood pressure in women with pregnancy-induced hypertension (PIH) or in those with de-novo diagnosis of hypertension in the puerperium. Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CCRCT), Embase, Medline, and PubMed were searched. The main inclusion criterion was articles regarding postnatal women with hypertension, therapeutic treatment for the management of hypertension compared with placebo or no therapy, with the exclusion of preeclampsia/eclampsia. Twenty-three studies were included. This review highlights significant evidence gaps, demonstrating that further comparative research is required, particularly to clarify postpartum antihypertensive selection. In conclusion, there is insufficient evidence to recommend a particular therapy or model of care, but calcium channel blockers, beta-blockers, alpha-blockers and angiotensin-converting enzyme inhibitors (ACEIs) appeared variably effective.

KEY WORDS: Pre-eclampsia; Hypertension; Pregnancy; Postpartum period; Antihypertensive agents