ABSTRACT
Objective
To assess the effectiveness and safety of management strategies for postpartum hypertension.
Data sources
We searched the Cochrane Pregnancy and Childbirth’s Trials Register in collaboration with their Information Specialist, on 20/October/2022. As the Pregnancy and Childbirth Review Group closed (2023), we updated our literature search on 17/September/ 2024 (topped up on 25/September/2025), using a strategy developed with an information specialist from the Royal College of Physicians, United Kingdom.
Study eligibility criteria
We included randomised controlled trials (RCTs) assessing any intervention (pharmacological, surgical, or models of care) used to reduce maternal blood pressure (BP) in participants with postpartum hypertension.
Study appraisal and synthesis methods
Search results were screened independently by two authors, with any disagreement resolved by consensus. Data were extracted independently, onto a Cochrane-based bespoke form which included Cochrane’s Trustworthiness Screening Tool. Random-effects meta-analysis was performed in RevMan.
Results
Of 944 studies identified, 40/44 included had informative data. Certainty of evidence was low or very low. There were no safety concerns. In seven trials (n=1113 participants) of diuretics (primarily furosemide) vs. placebo/no therapy, BP control was better with diuretics when administered alongside antihypertensive. In three trials (n=96) of antihypertensive vs. placebo, data were insufficient to inform effectiveness. In nine trials (n=865) of antihypertensive (4 types) vs. another (3 types) for non-severe hypertension, additional antihypertensive need was similar in comparisons with either nifedipine or methyldopa, but greater when amlodipine or either enalapril or lisinopril/thiazide were compared with nifedipine. In eight trials (n=403) of antihypertensive vs. another for severe hypertension, BP was lower with diltiazem (vs. nifedipine). In four trials (n=668) of uterine curettage vs. usual care, observed improvements in laboratory parameters were of unclear clinical significance. In nine trials (n=1263) of models of postnatal care (usually BP self-monitoring/management, N=6) vs. usual care, BP was lower eight months postpartum following BP self-monitoring/ management or lifestyle change.
Conclusions
While diuretics may aid in BP control, they cannot be recommended as monotherapy. Evidence guiding the optimal choice of antihypertensive agents remains limited. Of greatest relevance to practice is the effectiveness of: enalapril or amlodipine (vs. nifedipine) in controlling BP; and BP self-measurement/management or lifestyle change (vs. usual care) in preventing longer-term cardiovascular outcomes.