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Race/ethnicity differences in response to acute antihypertensive treatment of peripartum severe hypertension.
J Matern Fetal Neonatal Med. 2022 Dec; 35(25):10103-10109.JM

Abstract

BACKGROUND

Hypertensive disorders of pregnancy increase maternal morbidity, mortality, and long-term risk for cardiovascular disease. The rising incidence of chronic hypertension and preeclampsia disproportionately affects people of color. There is a paucity of published data examining differences in the effectiveness of acute antihypertensive agents between pregnant patients of different races/ethnicities. We aimed to determine if the effectiveness of acute antihypertensive agents for peripartum severe hypertension differs by race/ethnicity.

METHODS

A retrospective cohort study of patients with severe peripartum hypertension (systolic blood pressure ≥ 160 mmHg and/or diastolic blood pressure ≥ 110 mm Hg confirmed within 15 min) to determine whether the effectiveness of blood pressure control using nationally recommended medications (hydralazine, labetalol, nifedipine) differed by race/ethnicity. The primary outcome was reduction and maintenance of blood pressure to target ranges (140-150/90-100 mm Hg or below) for ≥4 h in each race/ethnicity group. Statistical tests included χ2, Fisher's exact, analysis of variance, and multivariable logistic regression.

RESULTS

Of 729 patients receiving treatment for severe peripartum hypertension, all medications were effective (overall 86.4% efficacy) at controlling blood pressure. Labetalol was the most effective medication in White patients (93.0 vs. 74.7% for nifedipine and 86.5% for hydralazine, p < .001). No overall differences in medication effectiveness were found in Black, Asian, or LatinX patients. Black and Asian patients were more likely to experience >1 hypertensive episode [51.0 and 49.0%, respectively vs. 35.4% (White) and 40.0% (LatinX), p = .008].

CONCLUSION

Currently recommended therapies for severe peripartum hypertension are effective in controlling blood pressure for ≥4 h in patients of all race/ethnic groups. Labetalol was the most effective medication in White patients with no overall differences in medication effectiveness in Black, Asian, or LatinX patients.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Greene NH
Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
Pon FF
Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
Kilpatrick SJ
Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA.

MeSH

PregnancyFemaleHumansAntihypertensive AgentsLabetalolNifedipinePeripartum PeriodEthnicityRetrospective StudiesHydralazineHypertensionBlood Pressure

Pub Type(s)

Journal Article

Language

eng

PubMed ID

36042568

Citation

Greene, Naomi H., et al. "Race/ethnicity Differences in Response to Acute Antihypertensive Treatment of Peripartum Severe Hypertension." The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, vol. 35, no. 25, 2022, pp. 10103-10109.
Greene NH, Pon FF, Kilpatrick SJ. Race/ethnicity differences in response to acute antihypertensive treatment of peripartum severe hypertension. J Matern Fetal Neonatal Med. 2022;35(25):10103-10109.
Greene, N. H., Pon, F. F., & Kilpatrick, S. J. (2022). Race/ethnicity differences in response to acute antihypertensive treatment of peripartum severe hypertension. The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 35(25), 10103-10109. https://doi.org/10.1080/14767058.2022.2116977
Greene NH, Pon FF, Kilpatrick SJ. Race/ethnicity Differences in Response to Acute Antihypertensive Treatment of Peripartum Severe Hypertension. J Matern Fetal Neonatal Med. 2022;35(25):10103-10109. PubMed PMID: 36042568.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Race/ethnicity differences in response to acute antihypertensive treatment of peripartum severe hypertension. AU - Greene,Naomi H, AU - Pon,Fay F, AU - Kilpatrick,Sarah J, Y1 - 2022/08/30/ PY - 2022/9/1/pubmed PY - 2022/11/24/medline PY - 2022/8/31/entrez KW - Hypertension treatment KW - preeclampsia with severe features KW - race/ethnicity KW - severe hypertension KW - severe maternal morbidity SP - 10103 EP - 10109 JF - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JO - J Matern Fetal Neonatal Med VL - 35 IS - 25 N2 - BACKGROUND: Hypertensive disorders of pregnancy increase maternal morbidity, mortality, and long-term risk for cardiovascular disease. The rising incidence of chronic hypertension and preeclampsia disproportionately affects people of color. There is a paucity of published data examining differences in the effectiveness of acute antihypertensive agents between pregnant patients of different races/ethnicities. We aimed to determine if the effectiveness of acute antihypertensive agents for peripartum severe hypertension differs by race/ethnicity. METHODS: A retrospective cohort study of patients with severe peripartum hypertension (systolic blood pressure ≥ 160 mmHg and/or diastolic blood pressure ≥ 110 mm Hg confirmed within 15 min) to determine whether the effectiveness of blood pressure control using nationally recommended medications (hydralazine, labetalol, nifedipine) differed by race/ethnicity. The primary outcome was reduction and maintenance of blood pressure to target ranges (140-150/90-100 mm Hg or below) for ≥4 h in each race/ethnicity group. Statistical tests included χ2, Fisher's exact, analysis of variance, and multivariable logistic regression. RESULTS: Of 729 patients receiving treatment for severe peripartum hypertension, all medications were effective (overall 86.4% efficacy) at controlling blood pressure. Labetalol was the most effective medication in White patients (93.0 vs. 74.7% for nifedipine and 86.5% for hydralazine, p < .001). No overall differences in medication effectiveness were found in Black, Asian, or LatinX patients. Black and Asian patients were more likely to experience >1 hypertensive episode [51.0 and 49.0%, respectively vs. 35.4% (White) and 40.0% (LatinX), p = .008]. CONCLUSION: Currently recommended therapies for severe peripartum hypertension are effective in controlling blood pressure for ≥4 h in patients of all race/ethnic groups. Labetalol was the most effective medication in White patients with no overall differences in medication effectiveness in Black, Asian, or LatinX patients. SN - 1476-4954 UR - https://www.unboundmedicine.com/medline/citation/36042568/Race/ethnicity_differences_in_response_to_acute_antihypertensive_treatment_of_peripartum_severe_hypertension_ DB - PRIME DP - Unbound Medicine ER -