Postpartum Hypertension, Tight vs Liberal Control Trial
Condition: Hypertension in the Obstetric Context
MeSH terms: Hypertension
Study type: Interventional

Summary: 
      To determine if treatment of less severe hypertension in the postpartum period results in a
      lower frequency of maternal morbidity.
    

Detailed description: 
      Patients with postpartum hypertension are at risk of developing preeclampsia, eclampsia, and
      severe maternal morbidity. About one-third of eclampsia occurs in the postpartum period.
      Fifty percent of intra-cerebral hemorrhages occurring in association with preeclampsia occur
      in the postpartum period. In addition to the maternal morbidity that may arise from severe
      hypertension in the postpartum period, additional consequences of inadequate blood pressure
      control include maternal readmission, its associated costs to the healthcare system, and its
      destabilizing effect on a new family. Furthermore, pregnant women with hypertensive disorders
      in pregnancy are at an increased risk of persistent postpartum hypertension and metabolic
      syndrome within the first year after delivery. Therefore, untreated postpartum hypertension
      may significantly impact on long term cardiometabolic outcomes for reproductive aged-women.

      Evidence-based guidance is lacking on the blood pressure threshold to initiate
      antihypertensive therapy in the postpartum period. Current clinical practice is extrapolated
      from management during pregnancy and no prior trials have been conducted on the threshold for
      initiation of antihypertensive medication in the postpartum period. A systematic review in
      2017 concluded "there is a lack of good quality evidence for postpartum management,
      emphasizing the need for further RCTs directly comparing different antihypertensive agents,
      BP threshold for medication adjustment and different models of care, with outcome measures
      other than postnatal readmissions" Based on low quality evidence/expert opinion ACOG and the
      National Institute of Heath and Care Excellence (NICE) in the UK both recommend initiating
      antihypertensive at a BP threshold of 150/100mmhg. NICE further recommends keeping BP lower
      than 140/90mmHg in patients with chronic hypertension and reducing antihypertensive
      medications when BP is less than 130/80mmHg in this population. ACOG does not mention at
      which BP threshold to reduce medications or when to stop antihypertensive therapy. There are
      obvious gaps in knowledge as stated in the systematic review. Therefore, our objective is to
      provide evidence to inform best practices with regards to the management of hypertension in
      the postpartum period through this randomized controlled trial.
    

Intervention name(s): Antihypertensive Agents
Intervention type(s): Drug
Intervention description(s): Antihypertensive medications will be initialed once BP is at predetermined threshold
Intervention MeSH terms: Antihypertensive Agents
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Multi-center Prospective Randomized Controlled Trial
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Postpartum; Hypertension