Data presented at SMFM 2025 favour nifedipine over labetalol for the management of hypertension in the postpartum period.

A single-institution, open-label study comparing the two antihypertensive agents evaluated 323 patients (average age 31 years) with at least two hypertensive blood pressure (BP) readings (>140 systolic or >90 diastolic) 4 hours apart during their admission for delivery. They were then randomized 1:1 to receive nifedipine 30 mg BID or labetalol 200 mg TID regardless of any prior treatment. [SMFM 2025, abstract 58]

“The primary outcome was statistically significant, representing a significant decrease in readmission in those taking nifedipine,” said Dr Todd Lovgren from the Nebraska Methodist Health System, Elkhorn, Nebraska, US, at SMFM 2025.

The primary outcome was readmission within 6 weeks of delivery due to complications of hypertension, which included MI, congestive heart failure, HELLP* syndrome, cerebrovascular accident, eclampsia, or preeclampsia with severe features (at least 160 mm Hg systolic BP or 110 mm Hg diastolic BP).

After controlling for clinical characteristics, the incidence of readmission for postpartum treatment of hypertension was markedly lower in the nifedipine arm at only 1.2 percent. In the labetalol arm, the corresponding rate was 8.1 percent. A comparison between treatment arms yielded an adjusted odds ratio (aOR) of 0.12 (95 percent confidence interval [CI], 0.026?0.57) in favour of the nifedipine vs labetalol arm.

There were no between-group differences in the frequency of severe hypertension, acute treatment of hypertension during hospitalization, use of magnesium sulphate, and hypertension within 12 hours of discharge.

“Postpartum hypertensive disease is a significant cause of maternal morbidity and mortality, and the optimal treatment is uncertain,” Lovgren said. “Coupled with published observational studies demonstrating similar results, this study supports nifedipine as the initial agent of choice in the ongoing management of hypertension in the postpartum period.”

Supporting data

The findings were supported by the results of a retrospective analysis involving birthing patients with peripartum hypertension at a quaternary care centre over 2 years. According to the investigators, led by presenting author Dr Jenny Mei from Stanford University, Mountain View, California, US, this analysis is part of an ongoing postpartum quality improvement project that entails lower BP targets and universal remote BP monitoring.

In this study, about a third (31.5 percent) of 6,410 deliveries were affected by hypertensive disorder of pregnancy. A total of 541 patients (26.8 percent) were discharged on a single medication, with the majority being prescribed nifedipine (80.6 percent) and the rest on labetalol (19.4 percent). [SMFM 2025, abstract 232]

Looking at the baseline characteristics, the labetalol arm had higher incidences of chronic hypertension (50.5 percent vs 17.9 percent; p<0.001), prenatal aspirin use (62.9 percent vs 46.8 percent; p=0.003), and vaginal delivery (65.7 percent vs 51.4 percent; p=0.008) compared with the nifedipine arm.

After adjusting for confounders, compared with nifedipine use, labetalol treatment was associated with significantly higher odds of readmission (20.8 percent vs 2.4 percent; aOR, 8.69, 95 percent CI, 1.45?52.11; p=0.001) and persistent hypertension as reflected by the higher incidence of antihypertensive use at 6 weeks postpartum (50 percent vs 22.6 percent; aOR, 2.33, 95 percent CI, 1.39?3.92; p<0.001) and continued antihypertensive use past 6 weeks postpartum (44.8 percent vs 16.6 percent; aOR, 2.78, 95 percent CI, 1.62?4.79; p<0.001).

Albeit falling short of statistical significance, labetalol was also associated with a higher incidence of postpartum ED visit or readmission compared with nifedipine (6.7 percent vs 1.8 percent; aOR, 2.84, 95 percent CI, 0.91?8.86; p=0.007).

Mei called for further investigation to help tailor the use of antihypertensives to the clinical needs of high-risk patients.