Efficacy of Pharmacological Agents for Management of Post-partum Hypertension: A Network Meta-analysis

Background Postpartum hypertension is a frequent cause of maternal morbidity and mortality and may occur as persistence of pregnancy-related hypertension or as new onset after delivery. Despite the burden, there is no consensus on the most effective antihypertensive drug regimen for the postpartum period. Pharmacological strategies vary widely, and treatment decisions are often extrapolated from antenatal studies rather than dedicated postpartum trials. Objectives The objective of this study was to compare the effectiveness and safety of pharmacological agents for management of postpartum hypertension. Study Design We performed a systematic review and Bayesian network meta-analysis of randomized controlled trials enrolling women with postpartum hypertension treated with systemic antihypertensive drugs. MEDLINE and Embase were searched through July 2025. Eligible trials compared active agents or placebo/usual care and reported blood pressure outcomes. Primary outcomes were time to achieve blood pressure control (hours) and proportion of women achieving blood pressure control within seven days postpartum. Treatment ranking was evaluated using surface under the cumulative ranking probability curves. Results Thirteen randomized controlled trials including 1625 women were identified. For time to blood pressure control, amlodipine and nifedipine ranked highest. Compared with labetalol, amlodipine reduced time to control by -5.85 hours (95% CI, -21.3 to 11.4) and nifedipine by -5.11 hours (95% CI, -17.9 to 9.71). Rankings indicated amlodipine were most effective for rapid control, followed by labetalol.For the proportion achieving control within seven days, labetalol ranked highest, with a probability near 100%. Compared with labetalol, 60 risk ratios for blood pressure control were 61 1.01 (95% CI, 0.55–1.75) for nifedipine, 1.03 (95% CI, 0.49–2.16) for hydralazine, and 1.31 (95% CI, 0.46–3.49) for hydrochlorothiazide–lisinopril. SUCRA values ranked labetalol highest, followed by nifedipine, hydralazine, and hydrochlorothiazide–lisinopril. Conclusions Calcium channel blockers appear most effective for rapid reduction of blood pressure after childbirth, while labetalol is most reliable for sustained control within the first postpartum week. These findings provide a comparative framework for treatment selection and emphasize the need for larger, rigorously designed postpartum hypertension trials.