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A study involving 57,254 pregnancies with hypertensive disorders reveals that discharge with nifedipine alone or multiple antihypertensive medications is associated with a lower incidence of postpartum readmission, while discharge with labetalol alone is linked to an elevated risk.

The following is a summary of “Risk of postpartum readmission after hypertensive disorder of pregnancy and variation by discharge antihypertensive medication prescription,” published in the January 2024 issue of Obstetrics and Gynecology by MITRO et al.

Patients with hypertensive disorders of pregnancy often face a heightened risk of postpartum readmission. In this retrospective cohort study encompassing 57,254 pregnancies with hypertensive disorders from 2012-2018 within Kaiser Permanente Northern California’s electronic obstetric database, researchers aimed to assess the association between antihypertensive medication prescribed at discharge and postpartum readmission within six weeks. Cox regression models were employed for this evaluation, adjusted for various factors, including type of hypertensive disorder, blood pressure, demographics, delivery-related variables, and comorbidities. 

Of the eligible patients with hypertensive disorders of pregnancy, 3.0% (1696) were readmitted within six weeks. Notably, 86% were discharged without antihypertensive medication, while among those with prescriptions, most received labetalol only (54%) or nifedipine only (30%). Unadjusted readmission risks varied, with the highest associated with labetalol only (7.6%), followed by nifedipine only (3.6%) or two or more antihypertensive medications (3.2%), and the lowest risk observed for those discharged without antihypertensive medication (2.5%). Adjusted models revealed that compared to discharge without antihypertensive medication, labetalol only was linked to a 63% higher incidence of postpartum readmission. In contrast, nifedipine only or two or more antihypertensive medications were associated with a 26% and 47% lower incidence, respectively. The results consistently indicated an elevated risk for labetalol, even in models excluding patients with pre-pregnancy hypertension. No compelling evidence suggested variations in the impact of discharge antihypertensive medication on readmission incidence based on race and ethnicity (interaction p=0.88). 

In conclusion, discharge on nifedipine alone or multiple antihypertensive medications demonstrated a lower incidence of readmission, whereas discharge on labetalol alone correlated with an elevated risk. This underscores the need for extensive prospective research to compare the effectiveness of commonly prescribed hypertension medications at discharge.

Source: sciencedirect.com/science/article/abs/pii/S0002937824000462