Hypertension-related morbidity after delivery discharge: A comparison of nifedipine versus labetalol.

OBJECTIVE: To evaluate rates of hypertension-related morbidity after delivery discharge among individuals on nifedipine versus labetalol monotherapy. METHODS: This was a retrospective cohort study of individuals who delivered at a level IV obstetric hospital from January 1, 2021 to January 20, 2024, had a hypertensive disorder of pregnancy, and were discharged on nifedipine or labetalol monotherapy. The primary outcome was hypertension-related post-discharge morbidity, defined as any of the following within 30 days of delivery discharge: severe hypertension, de novo preeclampsia lab abnormalities, or new-onset clinical morbidity (hemolysis, elevated liver enzymes and low platelets [HELLP] syndrome, eclampsia, pulmonary edema/acute heart failure, cerebrovascular disorders, myocardial infarction/cardiac arrest, liver hematoma, or acute renal failure). Secondary outcomes included hypertension-related hospital return and hospital return length of stay. Data were abstracted from the medical record. Logistic regression and bivariate analysis were used to compare groups. Multivariable logistic regression was used to adjust for baseline characteristics and readmission risk factors from the literature. RESULTS: Of 360 patients meeting inclusion criteria, 67.2% were discharged on nifedipine and 32.8% were discharged on labetalol. Nifedipine recipients had lower body mass index and were less likely to have chronic hypertension compared to labetalol recipients. Post-discharge morbidity occurred less frequently among individuals discharged on nifedipine compared to labetalol (1.7% vs. 10.2%; adjusted odds ratio [aOR], 0.1; 95% confidence interval [CI], 0.05-0.5). Individuals on nifedipine were less likely to return to the hospital in the 30 days following discharge (4.6% vs. 12.7%; aOR, 0.3; 95% CI, 0.1-0.7) and less likely to have a hospital return lasting ≥24 h (1.7% vs. 6.8%; OR, 0.2; 95% CI, 0.07-0.8). CONCLUSION: Among individuals on antihypertensive monotherapy at delivery discharge, nifedipine was associated with significantly reduced odds of post-discharge morbidity compared to labetalol.