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superiority trial should not be misinterpreted as proof that 4. Theilen LH, Fraser A, Hollingshaus MS, et al. All-cause and cause-
there is no difference between the groups. Equivalence and specific mortality after hypertensive disease of pregnancy. Obstet
Gynecol 2016;128:238-44.
noninferiority trials require larger sample sizes and alternate 5. American College of Obstetricians and Gynecologists; Task Force on
statistical measures. Hypertension in Pregnancy. Executive summary: hypertension in preg-
We would speculate that much of the concern that lead to nancy. Obstet Gynecol 2013;122:1122-31.
the task force recommendation is based on potentially rare 6. Johnson AG, Nguyen TV, Day RO. Do non-steroidal anti-inflammatory
complications of NSAID use and not a diffuse mild elevation drugs affect blood pressure? A meta-analysis. Ann Intern Med 1994;121:
289-300.
in mean arterial pressures. Much of the data from the 7. Snowden S, Nelson R. The effects of nonsteroidal anti-inflammatory
nonpregnant population show that there may be a small drugs on blood pressure in hypertensive patients. Cardiol Rev 2011;19:
subset of people particularly susceptible to NSAID-induced 184-91.
hypertension.18 Unfortunately, ruling out rare events will 8. Makris A, Thornton C, Hennessy A. Postpartum hypertension and
require much larger sample sizes as we move forward. nonsteroidal analgesia. Am J Obstet Gynecol 2004;190:577-8.
9. White PF. The changing role of non-opioid analgesic techniques in the
In addition, the comparison of acetaminophen to management of postoperative pain. Anesth Analg 2005;101(Suppl):
ibuprofen does not necessarily mimic actual clinical practice. S5-22.
It is the practice at our institution, and we assume many 10. Knights KM, Mangoni AA, Miners JO. Non-selective nonsteroidal
others, to use both acetaminophen and ibuprofen in combi- anti-inflammatory drugs and cardiovascular events: is aldosterone the
nation for postpartum analgesia. A more precise clinical silent partner in crime? Br J Clin Pharmacol 2006;61:738-40.
11. Scaife PJ, Mohaupt MG. Salt, aldosterone and extrarenal Na-
question might ask what is the effect of prescribing vs with- sensitive responses in pregnancy. Placenta 2017;56:53-8.
holding NSAIDs in addition to the standard analgesic care. 12. Hörl WH. Nonsteroidal anti-inflammatory drugs and the kidney.
This becomes important as we understand that acetamino- Pharmaceuticals (Basel) 2010;3:2291-321.
phen is also a COX-2 inhibitor and has some inhibitory effect 13. Rahman M, Wright JT Jr, Douglas JG. The role of the cytochrome
on prostaglandin synthesis.19 In fact, retrospective data from P450-dependent metabolites of arachidonic acid in blood pressure
regulation and renal function: a review. Am J Hypertens 1997;10:
the Nurses’ Health Study II showed that in otherwise healthy 356-65.
young women, acetaminophen use was more strongly asso- 14. Viteri OA, England JA, Alrais MA, et al. Association of nonsteroidal
ciated with hypertension than NSAIDs.20 antiinflammatory drugs and postpartum hypertension in women with
While this study by Blue and colleagues17 takes a crucial preeclampsia with severe features. Obstet Gynecol 2017;130:830-5.
step toward understanding the safety of NSAID use in women 15. Wasden SW, Ragsdale ES, Chasen ST, Skupski DW. Impact of non-
steroidal anti-inflammatory drugs on hypertensive disorders of preg-
with preeclampsia, many clinical questions remain. While nancy. Pregnancy Hypertens 2014;4:259-63.
research groups work to shed more light on this topic, cli- 16. Vigil-De Gracia P, Solis V, Ortega N. Ibuprofen versus acetamino-
nicians will continue to struggle with the task force recom- phen as a post-partum analgesic for women with severe pre-eclampsia:
mendations and their individual patients’ care. - randomized clinical study. J Matern Fetal Neonatal Med 2017;30:
1279-82.
17. Blue NR, Murray-Krezan C, Drake-Lavelle S, et al. Effect of ibuprofen
vs acetaminophen on postpartum hypertension in preeclampsia with
REFERENCES severe features: a double-masked, randomized controlled trial. Am J
1. Lo JO, Mission JF, Caughey AB. Hypertensive disease of pregnancy Obstet Gynecol 2018;218:616.e1-8.
and maternal mortality. Curr Opin Obstet Gynecol 2013;25:124-32. 18. De Leeuw PW. Nonsteroidal anti-inflammatory drugs and hyperten-
2. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet 2005;365: sion. The risks in perspective. Drugs 1996;51:179-87.
785-99. 19. Graham GG, Scott KF. Mechanism of action of paracetamol. Am J
3. Mogos MF, Salemi JL, Spooner KK, Mcfarlin BL, Salihu HH. Hyper- Ther 2005;12:46-55.
tensive disorders of pregnancy and postpartum readmission in the United 20. Curhan GC, Willett WC, Rosner B, Stampfer MJ. Frequency of
States: national surveillance of the revolving door. J Hypertens 2018;36: analgesic use and risk of hypertension in younger women. Arch Intern
608-18. Med 2002;162:2204-8.