A significant number of patients face ongoing high blood pressure issues after childbirth.
Approximately 20% of pregnant women in the US develop conditions like preeclampsia or gestational hypertension. However, due to gaps in evidence and guidelines, there is variability in how blood pressure is addressed after childbirth, as highlighted by the authors of a new study led by Dr. Alisse Hauspurg from the University of Pittsburgh School of Medicine.
The study revealed that 14% of patients had severe hypertension (≥ 160/110 mm Hg) within 6 weeks postpartum. Those with severe hypertension were more likely to visit the emergency department and face hospital readmission after discharge. This underscores the importance of remote monitoring at home.
Dr. Hauspurg emphasized the need for more clinical and research focus on this issue to understand blood pressure patterns post-delivery, address guideline gaps, and determine optimal management practices through large-scale trials.
The latest American College of Obstetricians and Gynecologists (ACOG) guidelines do not specify postpartum blood pressure targets for treatment, contributing to inconsistencies in managing hypertension post-delivery.
In a related editorial, Dr. Sadiya S. Khan from Northwestern University Feinberg School of Medicine pointed out the discrepancies in hypertension definitions among patients in the hospital and upon discharge, leading to varied postpartum hypertension management strategies and increased risk of readmission due to uncontrolled blood pressure.
Nurse-Led Remote Intervention and Communication
The study followed 2,705 postpartum patients for 6 weeks after discharge, providing them with an automatic BP monitor and educating them on its usage pre-discharge. Patients were guided to monitor their blood pressure regularly at home and report the readings to the nursing staff for assessment and intervention if needed.
Over 80% of patients experienced persistent hypertension, with about a quarter requiring new antihypertensive medication post-discharge, typically starting a week after giving birth. Only 14.6% achieved optimal blood pressure control after medication initiation.
Unresolved hypertension post-delivery led to more emergency department visits and hospital readmissions compared to patients with normalized blood pressure levels.
Patients with persistent hypertension were more likely to have a higher early-pregnancy body mass index, be Black, undergo a Cesarean delivery, or have public insurance.
Need for Further Research and Enhanced Strategies
The study recommended lower thresholds for initiating antihypertensive medications during hospitalization since many patients exhibited elevated blood pressure post-discharge. Dr. Hauspurg highlighted the importance of sustaining patient engagement postpartum and identifying factors affecting their participation, suggesting the use of biomarkers to predict worsening hypertension after discharge.
Longitudinal data on postpartum blood pressure trends could aid in establishing guidelines for monitoring hypertensive pregnant individuals after giving birth, emphasizing the need for strategies addressing social determinants of health in vulnerable populations.
