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Hypertension

Poster Session 1

(145) Acute treatment of severe hypertension in pregnancies with fetal growth restriction: Does medication choice matter?

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

To evaluate whether medication type affects time to resolution of acute severe hypertension (HTN) in pregnancies complicated by fetal growth restriction (FGR)

Study Design:

Passive prospective cohort analysis of patients with their first singleton gestations in which they received acute treatment for severe HTN at a single academic tertiary care center (2011-2020). This sub-analysis of duration of severe HTN after acute treatment was limited to pregnancies meeting Delphi consensus criteria for FGR. Those initially treated with either intravenous (IV) labetalol or hydralazine were compared with those treated with immediate release oral nifedipine. This study design was the result of visual inspection of nonparametric survival curves that revealed violation of the proportional hazards assumption when analyzing the three agents individually or combining pregnancies with and without FGR in the same analysis. A Cox proportional hazards model incorporated factors associated with time to resolution of severe hypertension up to two hours after treatment.

Results:

Of 998 patients with severe HTN, 331 (33%) met Delphi consensus criteria for FGR and, of these 301 underwent acute treatment of severe HTN with either IV labetalol (n=151), IV hydralazine (n=69), or oral nifedipine (n=81) as the initial medication of choice. Median time to resolution was 26 (IQR 23,31) vs 31 (IQR 27,35) minutes with nifedipine vs the IV agents respectively (Log-rank P < .001). After adjustment for pre-gravid BMI, treatment postpartum, and pre-treatment pulse pressure, 2 factors were independently associated with longer time to resolution of severe HTN: pre-treatment mean arterial pressure (MAP) >125 mmHg [adjusted hazard ratio (aHR) 0.63, 95%CI 0.49-0.80)] and requiring ³ 2 medication doses (aHR 0.53, 95%CI 0.41-0.69). The bias-corrected bootstrapped (1000 replicates) aHR for acute treatment with nifedipine is 1.48 (95% CI 1.13-1.95).

Conclusion:

Acute treatment with nifedipine is associated with a shorter time to resolution of severe hypertension compared to IV hydralazine and labetalol in pregnancies complicated by FGR.