The postpartum use of diuretics can reduce persistent hypertension in women with hypertensive disorders of pregnancy (HDP), according to the results of a systematic review and meta-analysis presented at SMFM 2025.

“Heterogeneity in study interventions and outcomes suggests that the optimal postpartum dosing and timing of diuretics in HDP warrants further study,” said lead author Dr Emma Trawick Roberts from the University of North Carolina, Chapel Hill, NC, US.

Roberts and her team carried out the study to systematically review the postpartum use of diuretics to manage persistent hypertension among women with HDP. They identified relevant studies using the databases of Medline, Ovid, Scopus, World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, and Cochrane from inception to April 2024.

A total of 571 randomized controlled trials (RCTs) that examined diuretics use postpartum in individuals with HDP were identified. Clinical characteristics and outcome measures were then extracted. Persistent hypertension postpartum was the primary outcome, while secondary outcomes included the use of additional antihypertensive drugs, length of stay, readmission/emergency visit, and breastfeeding.

Finally, Roberts and colleagues conducted a meta-analysis using a random effects model to estimate treatment effects through risk ratios (RRs) or mean difference with 95 percent confidence interval (CI).

Of the total RCTs identified, only eight met the eligibility criteria, with a total of 1,368 individuals (767 intervention and 771 control). The following interventions were performed in the included RCTs: furosemide (three RCTs), torsemide (one RCT), combined furosemide and antihypertensive drug (three RCTs), and combined thiazide/angiotensin-converting enzyme inhibitor (one RCT).

Persistent hypertension significantly decreased in the intervention groups relative to control groups (four RCTs, n=955; RR, 0.53, 95 percent CI, 0.35?0.80; I², 70 percent). The number needed to treat to make a significant reduction in persistent hypertension was four. [SMFM 2025, abstract 65]

Roberts also shared that “there was no difference in the need for additional antihypertensive medications during admission (seven RCTs, n=1,209; RR, 0.79, 95 percent CI, 0.61?1.02; I², 7 percent) or at the time of discharge (five RCTs, n=905; RR, 1.00, 95 percent CI, 0.82?1.21; I², 53 percent).

Likewise, no difference was seen in length of stay, readmission/emergency visits, or breastfeeding between groups.

Risk factors

A related study involving a total of 6,410 deliveries between April 2022 and April 2024 revealed several factors that may contribute to persistent hypertension requiring antihypertensive medications beyond 6 weeks postpartum. [SMFM 2025, abstract 231]

After adjusting for caesarean delivery and women on antihypertensive entering pregnancy, researchers identified the following factors that tend to increase the likelihood of persistent hypertension: non-Hispanic Black race (adjusted odds ratio [aOR], 2.97, 95 percent confidence interval [CI], 1.91?4.61; p<0.001), prenatal aspirin use (aOR, 1.43, 95 percent CI, 1.00?2.05; p=0.048), and having public or no insurance (aOR, 1.66, 95 percent CI, 1.09?2.53; p=0.02).

Other risk factors were as follows: pre-eclampsia with severe features (aOR, 1.62, 95 percent CI, 1.12?2.34; p=0.01), taking >1 antihypertensive drug (aOR, 2.80, 95 percent CI, 1.76?4.45; p<0.001), requiring antihypertension adjustment (aOR, 1.96, 95 percent CI, 1.37?2.79; p<0.0001), and postpartum emergency visit (aOR, 2.45, 95 percent CI, 1.17?5.11; p=0.02).

On the other hand, remote blood pressure monitoring helps reduce the chances of persistent hypertension (aOR, 0.23, 95 percent CI, 0.07?0.79; p=0.02).