{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:01:52Z","timestamp":1787756512880,"version":"build-2784847793"},"reference-count":48,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T00:00:00Z","timestamp":1734393600000},"content-version":"unspecified","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007344","name":"Achmea","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007344","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,11,11]]},"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>In the puerperium, women with hypertensive disease of pregnancy remain at risk for maternal complications. The antihypertensive agent prescribed antepartum is usually continued postpartum; however, evidence regarding the most effective treatment is lacking. Therefore, we aimed to investigate which antihypertensive agent results in optimal treatment (both effectiveness and safety) of postpartum hypertension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>MEDLINE (Ovid), Embase.com and CENTRAL were searched through 22 August 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Randomised controlled trials (RCTs) evaluating oral antihypertensives and diuretics in postpartum hypertensive women published after 1990, performing BP measurements in the postpartum period, were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>Two independent reviewers extracted data and assessed risk of bias. Pooled data were calculated as risk ratio or mean difference using a random effect model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fourteen RCTs (1651 women) were included. Seven RCTs compared diuretics with placebo or antihypertensive controlled, two RCTs compared oral antihypertensives with placebo and five RCTs compared labetalol with nifedipine. Pooled data demonstrated a significantly lower BP on day 3 in cases with pre-eclampsia using furosemide (mean difference \u22124.06, 95% CI \u22126.81 to \u22121.31). Furosemide had no significant effect on any of the other outcomes. Faster BP control was observed for labetalol over nifedipine in a single RCT (mean difference 5.20, 95% CI 4.36 to 6.04). No other significant effects were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this extensive literature review, no medication preference could be stated and a lack of high-quality studies was revealed. Some evidence demonstrates a positive effect on BP control in women with pre-eclampsia using furosemide. Therefore, adding furosemide to initial treatment is considerable. However, antihypertensive preference and furosemide effectiveness should be further researched. We propose a retrospective cohort study using real-life hospital data (from health records), utilising clinical variance in therapeutic strategies currently present.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42023410765.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-086208","type":"journal-article","created":{"date-parts":[[2024,12,21]],"date-time":"2024-12-21T05:52:17Z","timestamp":1734760337000},"page":"e086208","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Oral antihypertensive agents and diuretics in the management of hypertension in postpartum women: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7023-0274","authenticated-orcid":false,"given":"Rosalie J","family":"Hup","sequence":"first","affiliation":[{"name":"Department of Obstetrics, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina D","family":"Paauw","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A Titia","family":"Lely","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martine","family":"Depmann","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,12,20]]},"reference":[{"key":"2025121409395712000_14.12.e086208.1","article-title":"Antihypertensive drug therapy for mild to moderate hypertension during pregnancy","volume":"10","author":"Abalos","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121409395712000_14.12.e086208.2","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1089\/jwh.2018.7145","article-title":"Review of Cardiovascular Drugs in Pregnancy","volume":"28","author":"Kaye","year":"2019","journal-title":"J Womens Health (Larchmt)"},{"key":"2025121409395712000_14.12.e086208.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.309.6966.1395"},{"key":"2025121409395712000_14.12.e086208.4","unstructured":"Gynaecologie NVOe . Hypertensieve aandoeningen in de zwangerschap. Richtlijnendatabase. 2023."},{"key":"2025121409395712000_14.12.e086208.5","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1177\/2047487317730472","article-title":"Preventing cardiovascular disease after hypertensive disorders of pregnancy: Searching for the how and when","volume":"24","author":"Groenhof","year":"2017","journal-title":"Eur J Prev Cardiol"},{"key":"2025121409395712000_14.12.e086208.6","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.118.11726"},{"key":"2025121409395712000_14.12.e086208.7","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-013-9762-6"},{"key":"2025121409395712000_14.12.e086208.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.385301.BE"},{"key":"2025121409395712000_14.12.e086208.9","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000003480"},{"key":"2025121409395712000_14.12.e086208.10","doi-asserted-by":"crossref","unstructured":"Magee L , von Dadelszen P . Prevention and treatment of postpartum hypertension. Cochrane Database Syst Rev 2013;CD004351. doi:10.1002\/14651858.CD004351.pub3","DOI":"10.1002\/14651858.CD004351.pub3"},{"key":"2025121409395712000_14.12.e086208.11","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-018696","article-title":"Postpartum management of hypertensive disorders of pregnancy: a systematic review","volume":"7","author":"Cairns","year":"2017","journal-title":"BMJ Open"},{"key":"2025121409395712000_14.12.e086208.12","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.117.10803"},{"key":"2025121409395712000_14.12.e086208.13","unstructured":"Gynaecologists RCoOa . NICE guideline Hypertension in pregnancy - Evidence review for postnatal management of hypertension. 2019."},{"key":"2025121409395712000_14.12.e086208.14","doi-asserted-by":"crossref","DOI":"10.1016\/j.cpcardiol.2024.102584","article-title":"Evaluation of antihypertensives for post partum management of hypertensive disorders of pregnancy: A systematic review and meta-analysis","volume":"49","author":"Irfan","year":"2024","journal-title":"Curr Probl Cardiol"},{"key":"2025121409395712000_14.12.e086208.15","doi-asserted-by":"crossref","DOI":"10.3390\/healthcare10020325","article-title":"Antihypertensive Medications for Severe Hypertension in Pregnancy: A Systematic Review and Meta-Analysis","volume":"10","author":"Awaludin","year":"2022","journal-title":"Healthcare (Basel)"},{"key":"2025121409395712000_14.12.e086208.16","unstructured":"Hup RJ , Paauw ND , Depmann M , et al . CRD42023410765, Antihypertensive agents in postpartum women: a systematic review, 2023. Available: https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42023410765"},{"key":"2025121409395712000_14.12.e086208.17","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.b2700","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration","volume":"339","author":"Liberati","year":"2009","journal-title":"BMJ"},{"key":"2025121409395712000_14.12.e086208.18","unstructured":"Team TE . EndNote. EndNote X9 ed. Philadelphia, PA: Clarivate. 2013."},{"key":"2025121409395712000_14.12.e086208.19","unstructured":"The Cochrane Collaboration . n.d. Review Manager Web (RevMan Web). 5.4 ed: The Cochrane Collaboration."},{"key":"2025121409395712000_14.12.e086208.20","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"2025121409395712000_14.12.e086208.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.07.015"},{"key":"2025121409395712000_14.12.e086208.22","doi-asserted-by":"crossref","DOI":"10.1155\/2020\/5347918","article-title":"Efficacy of Diltiazem for the Control of Blood Pressure in Puerperal Patients with Severe Preeclampsia: A Randomized, Single-Blind, Controlled Trial","volume":"2020","author":"Arias-Hern\u00e1ndez","year":"2020","journal-title":"Int J Hypertens"},{"key":"2025121409395712000_14.12.e086208.23","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/01.AOG.0000148270.53433.66","article-title":"Postpartum preeclampsia management with furosemide: a randomized clinical trial","volume":"105","author":"Ascarelli","year":"2005","journal-title":"Obstet Gynecol"},{"key":"2025121409395712000_14.12.e086208.24","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/0002-9378(90)91011-Z","article-title":"The use of nifedipine during the postpartum period in patients with severe preeclampsia","volume":"162","author":"Barton","year":"1990","journal-title":"Am J Obstet Gynecol"},{"key":"2025121409395712000_14.12.e086208.25","doi-asserted-by":"crossref","first-page":"636","DOI":"10.3329\/bjms.v18i3.41640","article-title":"Efficacy of Postpartum Furosemide Therapy on Blood Pressure Recovery in Patients with Severe Preeclampsia: A Randomized Clinical Trial","volume":"18","author":"Dabaghi","year":"2019","journal-title":"Bangladesh J Med Sci"},{"key":"2025121409395712000_14.12.e086208.26","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajog.2023.01.015","article-title":"Oral combined hydrochlorothiazide and lisinopril vs nifedipine for postpartum hypertension: a comparative-effectiveness pilot randomized controlled trial","volume":"228","author":"Fishel Bartal","year":"2023","journal-title":"Am J Obstet Gynecol"},{"key":"2025121409395712000_14.12.e086208.27","doi-asserted-by":"crossref","unstructured":"Ainuddin J , Javed F , Kazi S . Oral labetalol versus oral nifedipine for the management of postpartum hypertension a randomized control trial. Pak J Med Sci 2019;35. doi:10.12669\/pjms.35.5.812","DOI":"10.12669\/pjms.35.5.812"},{"key":"2025121409395712000_14.12.e086208.28","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1080\/01443619750114040","article-title":"A randomised placebo controlled trial of loop diuretics in moderate\/severe pre-eclampsia, following delivery","volume":"17","author":"Matthews","year":"1997","journal-title":"J Obstet Gynaecol"},{"key":"2025121409395712000_14.12.e086208.29","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1161\/HYPERTENSIONAHA.120.16133","article-title":"Furosemide for Accelerated Recovery of Blood Pressure Postpartum in women with a hypertensive disorder of pregnancy: A Randomized Controlled Trial","volume":"77","author":"Lopes Perdigao","year":"2021","journal-title":"Hypertension"},{"key":"2025121409395712000_14.12.e086208.30","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1080\/10641955.2016.1231317","article-title":"Oral labetalol compared to oral nifedipine for postpartum hypertension: A randomized controlled trial","volume":"36","author":"Sharma","year":"2017","journal-title":"Hypertens Pregnancy"},{"key":"2025121409395712000_14.12.e086208.31","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1080\/10641955.2016.1239735","article-title":"Furosemide in postpartum management of severe preeclampsia: A randomized controlled trial","volume":"36","author":"Veena","year":"2017","journal-title":"Hypertens Pregnancy"},{"key":"2025121409395712000_14.12.e086208.32","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajog.2017.10.453","article-title":"42: Torsemide for prevention of persistent postpartum hypertension in preeclampsia: a randomized, placebo-controlled trial","volume":"218","author":"Viteri","year":"2018","journal-title":"Am J Obstet Gynecol"},{"key":"2025121409395712000_14.12.e086208.33","doi-asserted-by":"crossref","first-page":"S432","DOI":"10.1016\/j.ajog.2021.11.718","article-title":"A randomized controlled trial comparing the efficacy of nifedipine and enalapril in the postpartum period","volume":"226","author":"Yoselevsky","year":"2022","journal-title":"Am J Obstet Gynecol"},{"key":"2025121409395712000_14.12.e086208.34","first-page":"119","article-title":"Comparative Study between Oral Labetalol Vs Oral Labetalol with Oral Frusemide in Control of Blood Pressure among Postpartum Mothers with Severe Pre-Eclampsia","volume":"16","author":"Suganya","year":"2024","journal-title":"Int J Pharm Clin Res"},{"key":"2025121409395712000_14.12.e086208.35","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.1161\/HYPERTENSIONAHA.120.15875","article-title":"Postnatal Enalapril to Improve Cardiovascular Function Following Preterm Preeclampsia (PICk-UP):: A Randomized Double-Blind Placebo-Controlled Feasibility Trial","volume":"76","author":"Ormesher","year":"2020","journal-title":"Hypertension"},{"key":"2025121409395712000_14.12.e086208.36","unstructured":"Bozorgan TJ , Azadi P , Dehghani Z . Assessment of the effect of adding furosemide to antihypertensive treatment on postpartum hypertension in women with preeclampsia; a randomized clinical trial. J Renal Inj Prev 2022."},{"key":"2025121409395712000_14.12.e086208.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.09.002"},{"key":"2025121409395712000_14.12.e086208.38","first-page":"17","article-title":"The use of loop diuretics in the context of hypertensive disorders of pregnancy: a systematic review and meta-analysis","volume":"41","author":"Malham\u00e9","year":"2023","journal-title":"J Hypertens (Los Angel)"},{"key":"2025121409395712000_14.12.e086208.39","article-title":"Furosemide use as postpartum management in women with hypertensive disorder of pregnancy: A systematic review","volume":"38","author":"Ampri","year":"2020","journal-title":"J Hypertens (Los Angel)"},{"key":"2025121409395712000_14.12.e086208.40","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajog.2020.12.1007","article-title":"982 Postpartum diuretic therapy in women with preeclampsia: a meta-analysis","volume":"224","author":"Neuhoff","year":"2021","journal-title":"Am J Obstet Gynecol"},{"key":"2025121409395712000_14.12.e086208.41","doi-asserted-by":"crossref","first-page":"110196","DOI":"10.1016\/j.biopha.2020.110196","article-title":"Methyldopa as an inductor of postpartum depression and maternal blues: A review","volume":"127","author":"Wici\u0144ski","year":"2020","journal-title":"Biomed Pharmacother"},{"key":"2025121409395712000_14.12.e086208.42","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.l5119","article-title":"Diagnosis and management of hypertension in pregnancy: summary of updated NICE guidance","volume":"366","author":"Webster","year":"2019","journal-title":"BMJ"},{"key":"2025121409395712000_14.12.e086208.43","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.4.4.745"},{"key":"2025121409395712000_14.12.e086208.44","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(89)80579-7"},{"key":"2025121409395712000_14.12.e086208.45","doi-asserted-by":"publisher","DOI":"10.1007\/BF00544073"},{"key":"2025121409395712000_14.12.e086208.46","first-page":"182","article-title":"Nifedipine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy, in ischaemic heart disease, hypertension and related cardiovascular disorders","volume":"30","author":"Sorkin","year":"1985","journal-title":"Drugs (Abingdon Engl)"},{"key":"2025121409395712000_14.12.e086208.47","first-page":"198","article-title":"Enalapril. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension and congestive heart failure","volume":"31","author":"Todd","year":"1986","journal-title":"Drugs (Abingdon Engl)"},{"key":"2025121409395712000_14.12.e086208.48","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-086208","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T17:40:05Z","timestamp":1765734005000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-086208"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12]]},"references-count":48,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12,20]]},"published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1136\/bmjopen-2024-086208"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-086208","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12]]}}}