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Hypertension, Pregnancy-InducedPhase 4NCT04343235

Postpartum Management of Gestational Hypertensive Disorders Using Furosemide

A Phase 4 study testing furosemide and labetalol in people with Hypertension, Pregnancy-Induced, run by Wright State University at 1 site in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The main purpose of this study is to learn if incorporating a loop diuretic such as furosemide along with labetalol in the routine management of postpartum gestational hypertensive disorders could lower the need for additional anti-hypertensive agents to control blood pressures, improve blood pressures (as measured by… Read more about this study

Who is it for?
Ages 18 to 50 years, women only
Conditions the study is for
Hypertension, Pregnancy-Induced
What is being tested?
furosemide and labetalol
Could I receive a placebo?
No, everyone receives an active treatment
How many people
13 participants
Where
1 siteUnited States
Study dates
1 May 2020to 30 Jun 2022
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 50 years
  • Women only
  • No healthy volunteers
  • Adult

Who may be able to join

  • Postpartum women delivering at Miami Valley Hospital
  • Diagnosis of gestational hypertension or preeclampsia
  • Able to provide written informed consent

Who cannot join

  • Diagnosis of chronic hypertension
  • Allergy to study medications
  • Unable to understand English

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Miami Valley Hospital

    Dayton, Ohio, 45409

Other trials in United States

About this study

Official title: Postpartum Management of Gestational Hypertensive Disorders Using Furosemide: A Randomized Controlled Trial

  • The main purpose of this study is to learn if incorporating a loop diuretic such as furosemide along with labetalol in the routine management of postpartum gestational hypertensive disorders could lower the need for additional anti-hypertensive agents to control blood pressures, improve blood pressures (as measured by systolic blood pressure, diastolic blood pressure and mean arterial blood pressures), shorten hospital stays and decrease readmissions for patients with gestational hypertensive disorders.
  • Based on a study by Veena et al1, there is reason to believe that the addition of furosemide to other anti-hypertensives may help decrease the need to add or increase the dose of medication to control blood pressures. There may be potential to shorten hospital stays and decrease readmissions, as well. Collecting data will be done using a prospective, randomized 1:1 controlled study assigning postpartum patients with a gestational hypertensive diagnosis to either labetalol alone or labetalol plus furosemide.
  • The study will be performed in the postpartum wing of Miami Valley Hospital Main Campus and would use patients who have consented to participate in the study with enrollees coming from the OB Staff population.
Read the detailed description

Background and Literature Review

  • There have been four documented studies investigating loop diuretics in the management of postpartum hypertensive disorders- Matthews et al2, Ascarelli et al3, Amorim et al4, and Veena et al. Of these studies, only Amorim and Veena were able to show statistical significance on any parameters. Amorim was able to show that there was an improvement of SBP, DBP and MAP, but the research was only presented as an abstract at a conference and not published, thereby making it impossible to draw any conclusions or practice guidelines. Veena demonstrated that by using furosemide and nifedipine in combination, the need for additional antihypertensive medication in severe pre-eclampsia in the postpartum period was reduced when compared to nifedipine alone.
  • A systematic review5 of postpartum hypertensive disorder management suggested that there was insufficient data to recommend any single pharmacological intervention at this time in the management of gestational hypertensive disorders. The review emphasized the need for further studies to be conducted to help guide management of patients affected by gestational hypertensive disorders in the future.

Objectives

● Main Question

  • Does the use of furosemide plus labetalol improve blood pressures in the postpartum period of patients with gestational hypertensive disorders versus labetalol alone?
  • Primary ■ Will there be a requirement to escalate antihypertensive therapy to control blood pressures
  • Secondary
  • Improvement of gestational hypertensive disorders by measurement of systolic blood pressure, diastolic blood pressure and mean arterial pressure
  • Shortened hospital stay in patients with hypertensive disorders
  • Breastfeeding status at 1 week postpartum visit in mothers planning to breastfeed
  • Readmission for postpartum hypertensive disorders

Significance to patient, institution, and profession

  • As a referral center and being the region's leader, Miami Valley is very accustomed to accepting transfers of high acuity patients often times with hypertensive disorders being the root cause of the transport
  • The majority of the OB staff population being served at Miami Valley Hospital is African American. According to Myatt6, the incidence of pre-eclampsia in the African American population is greater than double the Caucasian population (11% to 5%) thereby making this study very applicable to the patient population served at Miami Valley Hospital.
  • With the construct of the study, costs abe kept low by utilizing already established resources and practices (blood pressure cuffs, nurses, routine one week blood pressure checks) while only adding on the unit cost of furosemide.
  • If treatment with labetalol and furosemide is found to be useful, it would be not only a very inexpensive, cost effective way of improving patient outcomes and possibly decreasing lengths of stay stateside, but in improving global practice in places that are lacking in resources privy to first world countries.

Methods

  • The study would be designed as:
  • A prospective randomized 1:1 controlled trial including postpartum women with gestational hypertension or preeclampsia
  • Patients with chronic hypertension would be excluded from the study
  • One arm receiving 200mg labetalol BID alone on PPD#1 or 24 hours after magnesium sulfate
  • One arm receiving 200mg labetalol BID and a five day course of furosemide 20mg QD on PPD#1 or 24 hours after magnesium sulfate
  • Recording any occurrence when an increased amount of labetalol is needed to maintain blood pressures below 150 SBP and/or 100 DBP per ACOG recommendations.7 ■ In the event of persistently elevated blood pressures, labetalol will be increased to 400mg TID and escalated to 600mg TID and finally 800mg TID as indicated
  • Measurement of blood pressure every four hours after administration until patient discharge
  • Measurement of urine output every 12 hours until discharge
  • Compare average systolic, diastolic and mean arterial pressures between the two groups during admission and at one week postpartum
  • Data will be collected using the OB Staff population at Miami Valley Hospital Main Campus.
  • The research will be analyzed and interpreted by the research team conducting the study.
  • Potential difficulties and limitations include compliance concerns of mandatory one week blood pressure follow up appointment.
  • Using the Veena et al paper as a frame of reference, a sample size of 140 divided evenly across the two treatment arms would achieve statistical significance in determining the need to escalate anti-hypertensive therapy.
  • The unit cost of one tablet of labetalol 200mg and furosemide 20mg is currently $0.32 and $1.23, respectively. 8,9
  • The study would use already readily available automated blood pressure cuff machines on the postpartum wing.
Being tested
furosemide, labetalol
Keywords
pregnancy induced hypertension, preeclampsia, furosemide
Medical subject headings
Hypertension, Pregnancy-Induced, Pre-Eclampsia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • furosemideDrug

    Also called lasix

    five day course of furosemide 20mg QD

  • labetalolDrug

    Also called trandate

    200mg labetalol BID

Study groups in NCT04343235
Study groupRoleWhat they receive
labetalol + furosemideExperimentallabetalol + furosemide
Receives: Drug: furosemide; Drug: labetalol
labetalol onlyActive comparatorlabetalol only
Receives: Drug: labetalol

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change of Dose for Antihypertensive Therapy

    number of patients who require a change in the dose of labetalol to control BP

    Measured: Change in dose of hypertensive therapy from randomization until hospital discharge (up to 7 days)

Secondary outcomes (6)
  1. Change of Gestational Hypertensive Disorder Symptoms (Systolic BP)

    average systolic blood pressure reading on Day 0, Day 1, and Day 2

    Measured: Average systolic blood pressure for Day 0, Day 1, and Day 2

  2. Change of Gestational Hypertensive Disorder Symptoms (Mean Arterial Pressure)

    average mean arterial pressure reading on Day 0, Day 1, and Day 2

    Measured: Average mean arterial pressure on Day 0, Day 1, and Day 2

  3. Change of Gestational Hypertensive Disorder Symptoms (Diastolic BP)

    average diastolic blood pressure reading on Day 0, Day 1, and Day 2

    Measured: Average diastolic blood pressure on Day 0, Day 1, and Day 2

  4. Hospital Length of Stay

    days in hospital after delivery

    Measured: Number of days of hospital stay from randomization to discharge

  5. Breastfeeding Status

    breastfeeding continuation after discharge

    Measured: at 1 week postpartum visit

  6. Hospital Readmission

    readmission for hypertension management

    Measured: up to 14 days after discharge

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Apr 2020
  2. Study start1 May 2020
  3. Primary completion30 Jun 2022
  4. Study completion30 Jun 2022

Why it stopped: Challenges with enrollment; primary investigator left the institution

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomized controlled trial
Masking
None (open label)
Enrolment
13 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04343235
Sponsor's protocol ID
06784
Status last verified
Sep 2023
First submitted
28 Oct 2019
Last updated
23 Oct 2023
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No: Data will be shared on a case by case basis

Publications

  • Veena P, Perivela L, Raghavan SS. Furosemide in postpartum management of severe preeclampsia: A randomized controlled trial. Hypertens Pregnancy. 2017 Feb;36(1):84-89. doi: 10.1080/10641955.2016.1239735. Epub 2016 Nov 11.

    PubMed 27835048
  • Matthews G, Gornall R, Saunders NJ. A randomised placebo controlled trial of loop diuretics in moderate/severe pre-eclampsia, following delivery. J Obstet Gynaecol. 1997 Jan;17(1):30-2. doi: 10.1080/01443619750114040.

    PubMed 15511760
  • Ascarelli MH, Johnson V, McCreary H, Cushman J, May WL, Martin JN Jr. Postpartum preeclampsia management with furosemide: a randomized clinical trial. Obstet Gynecol. 2005 Jan;105(1):29-33. doi: 10.1097/01.AOG.0000148270.53433.66.

    PubMed 15625138
  • Cairns AE, Pealing L, Duffy JMN, Roberts N, Tucker KL, Leeson P, MacKillop LH, McManus RJ. Postpartum management of hypertensive disorders of pregnancy: a systematic review. BMJ Open. 2017 Nov 28;7(11):e018696. doi: 10.1136/bmjopen-2017-018696.

    PubMed 29187414
  • Myatt L, Clifton RG, Roberts JM, Spong CY, Hauth JC, Varner MW, Thorp JM Jr, Mercer BM, Peaceman AM, Ramin SM, Carpenter MW, Iams JD, Sciscione A, Harper M, Tolosa JE, Saade G, Sorokin Y, Anderson GD; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. First-trimester prediction of preeclampsia in nulliparous women at low risk. Obstet Gynecol. 2012 Jun;119(6):1234-42. doi: 10.1097/AOG.0b013e3182571669.

    PubMed 22617589
  • Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013 Nov;122(5):1122-1131. doi: 10.1097/01.AOG.0000437382.03963.88. No abstract available.

    PubMed 24150027

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing furosemide and labetalol in people with Hypertension, Pregnancy-Induced, run by Wright State University at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 23 Oct 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 23 Oct 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change of Dose for Antihypertensive Therapy (time frame: Change in dose of hypertensive therapy from randomization until hospital discharge (up to 7 days)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04343235, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 23 Oct 2023.

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