Skip to main content

05-07-2024 | Hypertension | News

Hypertensive disorders of pregnancy associated with high rates of postpartum hypertension

Author: Ajay Jha


medwireNews: Hypertensive disorders of pregnancy (HDP) are linked to high rates of postpartum hypertension, leading to increased readmissions and emergency department visits in the first 6 weeks after discharge, US study findings indicate.

The results show that 81.8% of women had persistent hypertension after discharge, with a blood pressure (BP) of at least 140/90 mmHg, and 14.1% developed severe hypertension, as indicated by a BP of 160/110 mmHg or above.

Writing in JAMA Cardiology, Alisse Hauspurg (University of Pittsburgh School of Medicine, Pennsylvania) and colleagues say: “Our findings highlight the need for improvement in postpartum BP management in individuals with new-onset HDP.”

They add: “Despite our robust postpartum hypertension management program, the majority of individuals in our cohort had ongoing hypertension after discharge from the delivery hospitalization.”

The researchers note that “[t]he most recent ACOG [American College of Obstetricians and Gynecologists] guidelines do not explicitly state postpartum BP thresholds for treatment.” In prior guidelines, from the ACOG Task Force on Hypertension in Pregnancy, initiation of antihypertensives was recommended for a persistent BP of 150/100 mmHg or above.

For the study, the researchers enrolled 2705 postpartum women who had new-onset HDP, including preeclampsia, eclampsia, and gestational hypertension, or no prepregnancy hypertension and gave birth between September 2019 and June 2021.

All of the participants were enrolled in a remote BP monitoring and management program at a postpartum unit of a hospital. The mean age of the participants was 29.8 years, 18.0% were Black, and the median BMI in early pregnancy was 28.0 kg/m².

Each patient received an upper arm BP monitor, which they were trained to use so they could report BP measurements regularly via text message to a nurse-staffed call center. A physician reviewed the measurements and initiated or titrated antihypertensive medications based on clinical judgment. The primary outcomes of the study were readmission and emergency department visits within the first 6 weeks postpartum.

In all, 53.9% of individuals did not receive antihypertensive medications postpartum, 23.5% were discharged with antihypertensive medications, and 22.6% had antihypertensives initiated after hospital discharge. Among those who started medications after hospital discharge, antihypertensive treatment typically began 7 days postpartum.

The researchers report that rates of emergency department visits were significantly higher for patients with severe and persistent hypertension postpartum than for those whose BP was normal, at a respective 15.5% and 11.7% versus 7.7%. This was also true for hospital readmissions, at a corresponding 13.4% and 4.0% versus 2.7%.

After taking into account confounding factors, such as age, race, BMI, duration of hospital stay, and delivery type, women with severe hypertension had an increased likelihood for emergency department admission during the postpartum period and hospital readmission, at odds ratios of 1.85 and 6.75, compared with individuals with normal BP levels. The increased risk among women with persistent hypertension did not reach statistical significance.

Hauspurg and team suggest that “using lower thresholds for medication initiation during the inpatient delivery hospitalization may be reasonable given the expected exacerbation of hypertension after hospital discharge.”

Indeed, they found that women with a BP of 140/90 mmHg up to 150/100 mmHg during hospitalization had similar BP trajectories after discharge as women who had an inpatient BP of 150/100 mmHg or above.

“Our findings reinforce the critical role of remote BP monitoring in the postpartum period and suggest the need for further research to develop effective BP thresholds for antihypertensive medication initiation in the postpartum period,” write Hauspurg et al.

In a related Editor’s Note, Sadiya Khan, from the Northwestern University Feinberg School of Medicine in Chicago, Illinois, USA, points out a difference in the percentage of people who were eligible for antihypertensive medication on admission for delivery, depending on the criteria used, at 67.9% according to the American College of Cardiology/American Heart Association (ACC/AHA) criteria, compared with 38.7% using the ACOG criteria.

She says: “[T]he discordance between the ACC/AHA and ACOG criteria for targets representing optimal control of BP may be a major contributor to the observed heterogeneity in antihypertensive management strategies, and, subsequently, greater risk of readmission due to uncontrolled or severe hypertension.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2024 Springer Healthcare Ltd, part of the Springer Nature Group

JAMA Cardiol 2024; doi:10.1001/jamacardio.2024.1389
JAMA Cardiol 2024; doi:10.1001/jamacardio.2024.1386


Related topics

Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Medication non-adherence is a major barrier to effective healthcare delivery; half of all patients do not follow their doctor’s recommendations or treatment plan.

Our experts explain the fundamentals with a practical discussion of how to manage non-adherence in two common scenarios: hypertension and asthma control.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine