Does ibuprofen increase blood pressure among women with hypertensive disorders of pregnancy when given postpartum?

In this small trial, postpartum administration of ibuprofen to women with mild hypertensive disorders of pregnancy did not increase mean arterial blood pressure. Note that women with pre-existing chronic hypertensive disorders were excluded from this study. (LOE = 1b)

Penfield CA, McNulty JA, Oakes MC, Nageotte MP. Ibuprofen and postpartum blood pressure in women with hypertensive disorders of pregnancy: A randomized controlled trial. Obstet Gynecol 2019;134(6):1219-1226.  [PMID:31764732]

Randomized controlled trial (nonblinded)

Foundation

Concealed

Inpatient (any location)

In this randomized controlled trial, women with hypertensive disorders of pregnancy were randomized to receive oral ibuprofen 600 mg every 6 hours or acetaminophen 650 mg every 6 hours for postpartum analgesia. Sixty-two women were randomized, immediately after delivery, with concealed allocation and masked outcome assessment, but otherwise the authors did not describe masking. Women were eligible if they were at least 18 years old, had new onset of hypertension after 20 weeks' gestation, and no blood pressure measurements of 160 mm Hg systolic or 105 mm Hg diastolic. Women with chronic hypertension, or any medical conditions to contraindicate either study drug (eg, creatinine > 1.3 mg/dL, platelet count < 50,000, or liver transaminases > 500) were excluded. One woman in the control group was excluded after randomization because of a postpartum hemorrhage that required a blood transfusion. If additional analgesia was needed, opioids were available for women in either group, and did not differ between groups. Blood pressure was measured every 4 hours. There was no difference in average mean arterial blood pressure between groups (93 mm Hg +/- 8 vs 93 mm Hg +/- 7), and blood pressure trends over time did not differ. Women in both groups had good overall pain control, with average pain scores below their self-reported acceptable level as measured on a scale of 0 to 10.