Postpartum furosemide for accelerating recovery in patients with preeclampsia: A Randomized Placebo-Controlled Trial: Furosemide for postpartum hypertension.

Abstract

Background: Preeclampsia is a major hypertensive disorder of pregnancy, which may lead to severe complications, particularly in the first two weeks of the postpartum period. During the postpartum period, blood pressure levels remain high, often increasing to levels higher than those experienced during pregnancy. Furosemide, a fast-acting diuretic, reduces the intravascular volume overload and may represent an alternative to accelerate the normalization of blood pressure levels.

Objective: To evaluate the effectiveness of furosemide compared to placebo for blood pressure control in the postpartum period in women with severe preeclampsia.

Study design: In a triple-masked placebo-controlled randomized clinical trial, women in the postpartum period with de novo preeclampsia with severe features or eclampsia diagnosed during pregnancy and adequate diuresis, who had received magnesium sulfate, were randomized to receive furosemide (40 mg/day orally for five days) or placebo. The primary outcomes were mean blood pressure levels. Secondary outcomes were: frequency of severe hypertensive episodes, a continued need for antihypertensives, number of antihypertensives used to control blood pressure, length of hospital stay, adverse effects and maternal complications. A sample size of 120 patients was estimated, 60 in each arm of the study, based on the estimated difference between the mean systolic pressure of 142±12mmHg for the furosemide group and 153±19mmHg for the placebo group.

Results: Between June 20 and November 30, 2014, 271 women were screened and 120 were randomized to furosemide or placebo, with 118 being included in the final analysis (58 in the furosemide group and 60 in the placebo group). Most characteristics were similar in both groups. Mean daily systolic and diastolic pressure was lower in the furosemide group (P<0.001) and there were fewer episodes of severe hypertension on the second (P=0.04) and fifth (P=0.04) days. In addition, shorter time was required until blood pressure was controlled (P=0.01) in the furosemide group.

Conclusion: Compared to placebo, 40 mg/day of oral furosemide in patients with preeclampsia in the postpartum period reduced mean daily systolic blood pressure in 1^st and 5^th days and mean daily diastolic blood pressure in 1^st, 2^nd and 5^th days and the time required until blood pressure is controlled.