Furosemide for Accelerated Recovery of Blood Pressure Postpartum (ForBP)

University of Pennsylvania

Status and phase: Completed; Phase 2

Conditions: Hypertension, Pregnancy-Induced

Treatments: Drug: Oral furosemide; Drug: Placebo Oral Tablet

Study type: Interventional

Funder types: Other

Identifiers

NCT03556761

829444

Details and patient eligibility

About

A randomized, double-blind, placebo-controlled single center investigation of furosemide's effect on postpartum blood pressure control in pregnancies affected by hypertensive disorders of pregnancy

Full description

Hypertensive disorders of pregnancy are recognized causes of significant maternal/fetal morbidity and mortality, accounting for approximately 18% of maternal deaths worldwide. While significant research has been done on the evaluation and management of hypertension during pregnancy, studies of postpartum hypertension (PPHTN) are usually limited by their retrospective design and focus on inpatients in the immediate postpartum period (2-6 days), or patients who were readmitted due to complications related to hypertension. Few studies have investigated the incidence and proper management of hypertension in the postpartum period. Furthermore, in the United Kingdom, a review of maternal deaths determined that 10% were related to hypertensive disorders in pregnancy (HDP) in the postpartum period. Postpartum hypertension is also the cause of approximately 27% of readmissions to the hospital. These studies clearly show that PPHTN is associated with significant morbidity and that it is important to develop interventions that can reduce its effects.

In patients with HDP, postpartum blood pressure has been shown to decrease in the first 48 hours postpartum only to then increase in days 3-6 postpartum. This phenomenon is thought to be secondary to large fluid shifts, both secondary from fluid retention during the pregnant state as well as from fluids given intrapartum. Furthermore, large volumes of sodium are also mobilized into the intravascular compartment at this time. Given the latter, furosemide, a loop diuretic that mobilizes sodium and fluid excretion has been posed as a method to prevent severe range blood pressures and their associated maternal morbidity in the postpartum period.

Enrollment: 384 patients

Sex: Female

Ages: 18 to 55 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Hypertensive disorder of pregnancy diagnosed antepartum or intrapartum
• Gestational hypertension
• Pre-eclampsia with or without severe features
• Superimposed pre-eclampsia with or without severe features
• New diagnosis of HDP within 24 hours from delivery
• Postpartum, delivery ≥ 20 weeks estimated gestational age
• Age ≥18 years old

Exclusion criteria

• History of allergic reaction to furosemide
• High risk comorbidities for which treatment may be indicated or contraindicated: class C or higher diabetes mellitus, chronic kidney disease or baseline creatinine >1.2, cardiac disorders including cardiomyopathy, congenital heart disease, angina or coronary heart disease, rheumatic disease (lupus), sickle cell disease
• Baseline labs with K <3
• Use of furosemide or other diuretics antepartum or intrapartum
• Use of ototoxic agents including aminoglycosides (ie, Gentamicin for >1 dose), cephalosporins (ie Ancef >1 dose),
• Patient unstable for protocol per investigator's judgement

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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384 participants in 2 patient groups, including a placebo group

Oral furosemide

Experimental group

Description:

Oral furosemide 20 mg/day for a total of 5 consecutive doses.

Treatment:

Drug: Oral furosemide

Placebo Oral Tablet

Placebo Comparator group

Description:

Placebo once per day for a total of 5 consecutive doses.

Treatment:

Drug: Placebo Oral Tablet