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.