Postpartum hypertension found to continue after birth in 80% of patients, study finds
The cohort study of patients with hypertensive disorders of pregnancy highlights the importance of remote blood pressure monitoring programs and improved tools for risk stratification, according to its authors.
More than 80% of women with hypertensive disorders during pregnancy had hypertension after their pregnancies, with approximately 14% developing severe cases, a study found.
Researchers conducted a cohort study of a population-based sample of individuals with a new-onset hypertensive disorder of pregnancy (preeclampsia or gestational hypertension) and no prepregnancy hypertension who delivered from September 2019 to June 2021. Participants were enrolled in a remote blood pressure (BP) monitoring and management program at a postpartum unit at a referral hospital. Results were published by JAMA Cardiology on June 12.
Among 2,705 patients in the cohort (mean age, 29.8 years), 2,214 (81.8%) had persistent hypertension postpartum, 382 (14.1%) developed severe hypertension, and 610 (22.6%) were prescribed antihypertensive medication. Those with severe hypertension had increased odds of postpartum ED visits (adjusted odds ratio [OR], 1.85; 95% CI, 1.17 to 2.92) and hospital readmissions (adjusted OR, 6.75; 95% CI, 3.43 to 13.29) compared with those whose BPs normalized.
When inpatient postpartum BP categories were compared with outpatient home BP trajectories, there was significant overlap among those with inpatient systolic BP greater than or equal to 140 to 149 mm Hg and/or diastolic BP greater than or equal to 90 to 99 mm Hg and those with systolic BP greater than or equal to 150 mm Hg and/or diastolic BP greater than or equal to 100 mm Hg, the study authors noted.
They concluded that the study supports the critical role of remote BP monitoring programs, highlights a need for improved tools for risk stratification, and could inform a liberalization of thresholds for starting medication postpartum.
The study highlights several critical gaps in evidence-based recommendations for monitoring and managing BP after a pregnancy complicated by hypertension, an accompanying editorial noted.
"HDPs [hypertensive disorders of pregnancy] are increasing in frequency and are associated with significantly higher risk of adverse maternal and neonatal outcomes in the peripartum period," the editorial stated. "In addition, there is growing recognition that more intensive prevention measures may be warranted for individuals who experience HDP, given the higher lifetime risk of cardiovascular disease following a pregnancy complicated by HDP."
I.M. Matters from ACP addressed postpartum care in its lead June cover story, highlighting how increased collaboration and communication between obstetrics/gynecology and primary care are crucial to improve maternal outcomes in the United States.