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Comparing the efficacy of oral labetalol with oral amlodipine in achieving blood pressure control in women with postpartum hypertension: randomized controlled trial (HIPPO study—Hypertension In Pregnancy & Postpartum Oral-antihypertensive therapy)

Journal of Human Hypertension volume 37, pages 1056–1062 (2023)Cite this article

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Abstract

De novo - or as a continuum of antenatal hypertension -postpartum hypertension complicates ~2% of pregnancies. Many maternal complications, such as eclampsia and cerebrovascular accidents, occur in the postpartum period. Despite widespread use of antihypertensives during pregnancy and childbirth, there is a paucity of data on preferred medications in the postpartum period. This randomized controlled study enrolled 130 women who were started on antihypertensives. They were randomized to receive oral Labetalol(LAB, maximum 900 mg per day in three doses) or oral Amlodipine(AML, maximum 10 mg per day given in two doses). In the immediate postpartum, all women were closely monitored for neurological symptoms, blood pressure, heart rate, respiratory rate, urine output, and deep tendon reflex. The primary outcome was the time to achieve sustained blood pressure control for 12 h from the initiation of medication; secondary outcomes included side effects of both medications. Mean time to achieve sustained blood pressure control was lower in women who received AML than in those who received LAB-(mean difference 7.2 h; 38 95% CI 1.4, 12.9, p = 0.011). There were fewer severe hypertensive episodes among those with AML than in those who received LAB. However, the proportion of women who continued to require antihypertensives at discharge was higher in the AML group than in the LAB group (55.4% versus 32.3%, p = 0.008). None of the participants developed drug-related side effects. Among women with postpartum persistence or new-onset hypertension, oral AML achieved sustained blood pressure control in a shorter duration, with fewer hypertensive emergencies than oral LAB. (CTRI/2020/02/023236).

Trial Registration details: The study protocol was registered with Clinical Trial Registry of India with CTRI Number CTRI/2020/02/023236 dated 11.02.2020. Protocol can be accessed at https://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=40435&EncHid=&modid=&compid=%27,%2740435det%27.

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The data underlying this paper will be shared on reasonable request to the corresponding author.

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Authors and Affiliations

  1. Departments of Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, 605006, India

    Avantika Gupta, Deepthi Nayak, Jyotsna Sharma & Anish Keepanasseril

  2. Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), Nagpur, India

    Avantika Gupta

  3. Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, India

    Deepthi Nayak

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Contributions

AK and AG conceived the study. All authors contributed to the design. DN, and JS carried out the data collection and guarantees data integrity. AK performed statistical analyses. AG, JS, and DN reviewed the analysis, and AK and JS wrote the first draft. All authors contributed to revising and finalization of the paper. AK (corresponding author) guarantees all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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Correspondence to Anish Keepanasseril.

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Gupta, A., Nayak, D., Sharma, J. et al. Comparing the efficacy of oral labetalol with oral amlodipine in achieving blood pressure control in women with postpartum hypertension: randomized controlled trial (HIPPO study—Hypertension In Pregnancy & Postpartum Oral-antihypertensive therapy). J Hum Hypertens 37, 1056–1062 (2023). https://doi.org/10.1038/s41371-023-00841-x

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