(428) Oral Physiologic vs Non-Physiologic Treatment of Blood Pressure in Preeclampsia with Severe Features

Evaluate the impact of physiologic blood pressure treatment in preeclampsia with severe features using pulse pressure as a surrogate for preeclampsia phenotype.

Study Design:

This retrospective cohort study included patients with preeclampsia with severe features admitted to a tertiary academic medical center from 2014-2024, prior to 34 weeks gestation. Chronic hypertension patients were excluded. Physiologic treatment was defined by vasoconstrictive (MAP < 65 mm Hg) or hyperdynamic (MAP ≥ 65 mm Hg) physiology, treated with nifedipine or labetalol, respectively. The primary outcome was latency period from admission to delivery. Secondary outcomes included gestational age at delivery, number of hospital days, delivery method, IV medications, PO medications, classical hysterotomy, and pulmonary edema. Statistical analyses were performed using Chi-square and Mann-Whitney tests.

Results:

Of 156 patients, 78 received physiologic treatment and 77 received non-physiologic treatment. No differences were found in latency period (5.51 vs. 5.04 days, p=0.204), gestational age at delivery (30w1d vs. 30w2d, p=0.356), hospital days (8.71 vs. 8.27, p=0.381), or IV medications (3.28 vs. 2.73, p=0.182). Patients receiving physiologic treatment took more daily PO medications (1.31 vs. 1.13, p=0.036). No significant differences were observed in delivery method, classical hysterotomy, or pulmonary edema. Even when analyzing patients delivered only for uncontrolled blood pressure, no differences in outcomes were found. Patients with a vasoconstrictive phenotype had more fetal growth restriction (50.5% vs. 36.5%, p=0.044), while those with a hyperdynamic phenotype were more likely to develop pulmonary edema (19.2% vs. 4.9%, p=0.014).

Conclusion:

Physiologic treatment did not affect latency to delivery or other clinical outcomes. Pulse pressure as a surrogate for blood pressure phenotype did not improve outcomes. The vasoconstrictive phenotype was associated with fetal growth restriction, while the hyperdynamic phenotype was linked to pulmonary edema.