(1177) Furosemide for the prevention of de novo postpartum hypertension: A randomized placebo-controlled trial

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: Furosemide has been found to decrease morbidity in patients with preeclampsia, but whether it can prevent de novo postpartum hypertension (PP HTN) is unknown. We sought to evaluate whether furosemide can prevent de novo PP HTN among individuals at increased baseline risk.

Study Design: This is a randomized placebo-controlled trial (NCT04752475) of birthing people at high risk for de novo PP HTN delivering at a tertiary care center in NYC. To determine enrollment eligibility, we applied an algorithm intended to identify normotensive individuals with ≥1 high risk factor or ≥2 moderate risk factors to develop de novo PP HTN, as adapted from the USPSTF preeclampsia risk assessment recommendations (Figure 1). Participants were randomly assigned to receive 5 days of oral furosemide 20mg daily or identical placebo within 8 hours of delivery and followed for 6 weeks. The primary outcome was difference in mean arterial pressure (MAP) averaged over 24 hours prior to discharge or prior to antihypertensive therapy initiation (whichever occurred first). Rates of de novo PP HTN and other secondary medical, obstetrical, and infant outcomes were assessed at discharge, 2 weeks, and 6 weeks postpartum. Analyses were performed according to the intention-to-treat principle.

Results: From October 2021 to April 2022, 891 patients were screened and 82 were randomized (Figure 1). The overall rate of de novo PP HTN was 10% (n=8). The mean MAP 24 hours prior to discharge or antihypertensive initiation was 88.9 ± 7.4mmHg in the furosemide group and 86.8 ± 7.1mmHg in the placebo group (difference 2.1mmHg, 95% CI -1.2, 5.3) (Table 1). De novo PP HTN occurred in 5 (12.5%) in the furosemide group and 3 (7.7%) in the placebo group (RR 1.6, 95% CI 0.4, 6.3). There were no significant differences in any secondary outcomes.

Conclusion: Our algorithm identifies a population at high risk for developing de novo PP HTN. There is insufficient evidence to suggest that furosemide reduces mean MAP in the 24 hours prior to discharge from delivery hospitalization or prior to antihypertensive medication initiation compared to placebo.

Primary & Presenting Author(s)

Ukachi N. Emeruwa, MD, MPH (she/her/hers)
Assistant Professor, WRHR Scholar
University of California San Diego
San Diego, CA, United States

Coauthor(s)
HA
Hooman Azad, MD, MPH
Columbia University Irving Medical Center
New York, New York, United States

SO
Samsiya Ona, MD
Columbia University Irving Medical Center
New York, New York, United States

SB
Shai Bejerano, MS
Department of Obstetrics and Gynecology, Vagelos College of Physician and Surgeons, Columbia University
New York, New York, United States

SA
Sarah Alnafisee, MD
MB; Obstetrics & Gynaecology
Columbia University
New York, New York, United States

JE
Jordan Emont, MD, MPH, MSc
Columbia University Irving Medical Center
New York, New York, United States

SM
Sharon Mathew, BA
Clinical Research Coordinator
Columbia University Irving Medical Center
New York, New York, United States

MB
Michelle Batlle, BA
Columbia University Vagelos College of Physicians and Surgeons
New York, New York, United States

DA
Denice Arnold, BS
Columbia University Vagelos College of Physicians and Surgeons
New York, New York, United States

Erinma P. Ukoha, MD, MPH (she/her/hers)
Clinical Fellow
Columbia University Medical Center
New York, New York, United States

Ja
Janice aubey, MD
Columbia University Irving Medical Center
New York, New York, United States

Mary E. D'Alton, MD
Obstetrician and Gynecologist-in-Chief Willard C. Rappleye Professor and Chair
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
New York, New York, United States

RM
Russell S. Miller, MD
Sloane Hospital for Women Associate Professor of Prenatal Pediatrics (in Obstetrics and Gynecology)
Columbia University Medical Center
New York, New York, United States

Cynthia Gyamfi-Bannerman, MD, MS (she/her/hers)
Professor and Chair
University of California San Diego
La Jolla, California, United States