Comparison of Oral and Intravenous Nitroglycerin in the Treatment of Acute Postpartum Hypertension After Cesarean Delivery for Preeclampsia.

BACKGROUND

Acute postpartum hypertension is common among women with preeclampsia, particularly after cesarean delivery, and is traditionally managed with intravenous (IV) antihypertensive agents. However, evidence directly comparing IV nitroglycerin-based regimens with oral-only strategies is limited.

AIM: To compare the efficacy of oral-only antihypertensive therapy versus IV nitroglycerin-based regimens in achieving 24-hour blood pressure control among women with preeclampsia after cesarean delivery.

METHODS

In this two-center retrospective cohort study, we included women with preeclampsia who developed acute hypertension within 24 hours after cesarean delivery. Patients were categorized into three groups: oral-only therapy, IV nitroglycerin plus oral therapy, and IV nitroglycerin-only regimens. The primary outcome was 24-hour blood pressure control (systolic <160 mmHg and diastolic <110 mmHg). Secondary outcomes included 30-day healthcare utilization and in-hospital complications. Multivariable regression models adjusted for baseline characteristics.

RESULTS

All strategies achieved substantial blood pressure reduction. Rates of 24-hour control were high and comparable across groups ( P = 0.941), with no significant advantage of IV nitroglycerin over oral-only therapy after adjustment. Short-term clinical outcomes, including 30-day emergency visits ( P = 0.930) and in-hospital complications ( P = 0.810), were similar across groups. In subgroup analyses, IV nitroglycerin and oral nifedipine yielded similar hemodynamic responses.

CONCLUSION

Oral-only therapy provides 24-hour blood pressure control and short-term outcomes comparable with resource-intensive IV nitroglycerin regimens. In stable postpartum patients, oral therapy can be used as first-line management.