Risk of postpartum readmission after hypertensive disorder of pregnancy and variation by discharge antihypertensive medication prescription

The authors of this paper note that an increasing number of people are being readmitted to the hospital within six weeks of discharge home after delivery and that many of these persons had a hypertensive disorder of pregnancy (HDP). Utilizing data from Kaiser Permanente Northern California, researchers reviewed cases of 57,254 patients who delivered between 2012 and 2018 and had an HDP diagnosis such as gestational hypertension or various forms of preeclampsia. Out of these patients, 1,696 of them were readmitted within six weeks post-delivery.

A significant portion of the study focused on the medication prescribed upon discharge. The findings revealed that 86% of patients who did not receive a prescription for an anti-hypertensive medication had a 2.5 % readmission rate. In contrast,  those prescribed labetalol only had a higher readmission rate of 7.6%, and those prescribed nifedipine only had a readmission rate of 3.6%. Those on a combination of two or more medications had a rate of 3.2 %.

After adjusting for factors like the type of HDP, delivery facility, last inpatient blood pressure, mode of delivery, preterm delivery, and patient demographics, it was found that those discharged on labetalol were 63% percent more likely to be readmitted compared to those without any medication. Conversely, those on nifedipine were 26% less likely, and those on 2 or more drugs 47% less likely, to be readmitted compared to the no-medication group.

The study highlighted that nifedipine’s once or twice daily dosage might improve complicance compared to labetalol, which requires more frequent dosing. Additionally, nifedipine is thought to enhance renal blood flow, potentially aiding in resolving preeclampsia-related renal changes more effectively than labetalol.

The authors concluded that further research is necessary to assess the comparative effectiveness of commonly prescribed antihypertensive medications at discharge for managing hypertension in postpartum patients.


Take Home:  After controlling for multiple associated risk factors, those with a diagnosis of a HDP have a significantly lower risk of readmission to the hospital after being discharged with nifedipine compared to labetalol.  

Link: https://www.ajog.org/article/S0002-9378(24)00046-2/abstract

Citation: Mitro, S. D., Hedderson, M., Xu, F., Forquer, H., Baker, J. M., Kuzniewicz, M. W., & Greenberg, M. (2024). Risk of postpartum readmission after hypertensive disorder of pregnancy and variation by discharge antihypertensive medication prescription. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2024.01.015 

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