ANTIHYPERTENSIVE TREATMENT PATTERNS BEFORE AND DURING PREGNANCY AMONG WOMEN WITH CHRONIC HYPERTENSION: A REAL-WORLD EHR STUDY
Author(s)
Ahmed M. Kamel, B.Pharm1, Jingjing Qian, PhD1, Kimberly B. Garza, MBA, PharmD, PhD1, Pankush Kalgotra, PhD2, Rachel Urrutia, MD, MS3, Matthew Shane Loop, PhD1;
1Auburn University Harrison School of Pharmacy, Auburn, AL, USA, 2Raymond J. Harbert College of Business, Auburn University, Auburn, AL, USA, 3Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
1Auburn University Harrison School of Pharmacy, Auburn, AL, USA, 2Raymond J. Harbert College of Business, Auburn University, Auburn, AL, USA, 3Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
OBJECTIVES: Clinical guidelines for managing chronic hypertension in pregnancy differ in their recommendations for first-line therapy. Labetalol, nifedipine, and methyldopa are frequently recommended, but guidance varies across organizations. Describing real-world antihypertensive use before pregnancy and across gestation helps clarify current practice and inform future guideline development.
METHODS: We conducted a retrospective cohort study using electronic health record data from the University of Alabama at Birmingham from 2016 to 2025. Pregnant individuals with chronic hypertension were identified using validated diagnosis codes recorded before or at 20 weeks’ gestation. Antihypertensive medication use was assessed and compared using Pearson’s Chi-square test during four periods: pre-conception, as well as the first, second, and third trimesters.
RESULTS: Among 556 pregnant women with chronic hypertension, antihypertensive treatment before conception was dominated by calcium channel blockers and beta-blockers, with amlodipine (30.7%), nifedipine (24.4%), and labetalol (20.3%) being the most prescribed medications, while renin-angiotensin system inhibitors were still frequently prescribed (losartan: 2.8%). Compared to the pre-conception period, the distribution of antihypertensive agents differed in the first trimester (p < 0.001). During the first trimester, labetalol became the most used agent (42.6%), followed by nifedipine (31.6%) and amlodipine (18.8%). The distribution of medications differed significantly between the first and second trimesters (p < 0.001), with labetalol use increasing to 46.1% and amlodipine use dropping to 1.5%. Finally, the distribution of medications differed between the second and third trimesters (p<0.001), with a decrease in labetalol to 36.0% and a resurgence of amlodipine to 10.7%. Methyldopa use was rare across all pregnancy stages (<0.3%).
CONCLUSIONS: In this real-world cohort, a shift toward more guideline-recommended drugs in pregnancy (labetalol and nifedipine) happened between pre-conception and pregnancy. However, the use of other non-first-line drugs, such as amlodipine, and a low prevalence of the recommended drug methyldopa was observed.
METHODS: We conducted a retrospective cohort study using electronic health record data from the University of Alabama at Birmingham from 2016 to 2025. Pregnant individuals with chronic hypertension were identified using validated diagnosis codes recorded before or at 20 weeks’ gestation. Antihypertensive medication use was assessed and compared using Pearson’s Chi-square test during four periods: pre-conception, as well as the first, second, and third trimesters.
RESULTS: Among 556 pregnant women with chronic hypertension, antihypertensive treatment before conception was dominated by calcium channel blockers and beta-blockers, with amlodipine (30.7%), nifedipine (24.4%), and labetalol (20.3%) being the most prescribed medications, while renin-angiotensin system inhibitors were still frequently prescribed (losartan: 2.8%). Compared to the pre-conception period, the distribution of antihypertensive agents differed in the first trimester (p < 0.001). During the first trimester, labetalol became the most used agent (42.6%), followed by nifedipine (31.6%) and amlodipine (18.8%). The distribution of medications differed significantly between the first and second trimesters (p < 0.001), with labetalol use increasing to 46.1% and amlodipine use dropping to 1.5%. Finally, the distribution of medications differed between the second and third trimesters (p<0.001), with a decrease in labetalol to 36.0% and a resurgence of amlodipine to 10.7%. Methyldopa use was rare across all pregnancy stages (<0.3%).
CONCLUSIONS: In this real-world cohort, a shift toward more guideline-recommended drugs in pregnancy (labetalol and nifedipine) happened between pre-conception and pregnancy. However, the use of other non-first-line drugs, such as amlodipine, and a low prevalence of the recommended drug methyldopa was observed.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH88
Topic
Epidemiology & Public Health
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)