1033 Racial disparities in the treatment of severe postpartum hypertension

Abstract

Our objective was to determine if the time to treat (TTT) severe hypertension varied based on race on the inpatient postpartum units. We performed a retrospective cohort study of patients delivered between 1/2017-9/2019 at Magee-Womens Hospital of the University of Pittsburgh Medical Center (UPMC). Women with 2 or more severe range blood pressures (BP) sustained for ≥15 minutes in the postpartum period were identified utilizing data collected by UPMC’s Clinical Analytics Department. TTT was defined as the time from the first severe range BP to administration of the first rapid-acting antihypertensive agent. TTR was defined as the time from the first severe range BP to BP<150/100 mmHg. We performed a univariate analysis using Student’s T-Test and Wilcoxon Rank Sum test to compare TTT and TTR by self-reported race. 302 women met inclusion criteria: 103 women of Black race and 199 women of other races (predominantly White). Women of Black race were younger (29.2 (SD 6.7) vs 32.6 (SD 5.5) years, p <0.001), were less likely to be primiparous (39.8% vs 54.6%, p=0.02), and were more likely to have public insurance (84.3% vs 36.4%, p <0.001). The Non-Hispanic Black cohort trended toward more chronic hypertension and superimposed pre-eclampsia but this difference was not statistically significant, p=0.7. Of the total 302 women with sustained severe range BPs, only 50.5% were treated with rapid-acting antihypertensive. The median TTT in our Non-Hispanic Black cohort was 45 minutes (IQR 29-70) and 47 minutes (IQR 33-81) in our Other cohort, p=0.4. The median TTR in our Non-Hispanic Black cohort was 120 (IQR 50-202) and 109 (IQR 60-203) in our Other cohort, p=0.9. In our cohort, there was no difference in acute management of severe hypertension postpartum by race. however, only 50.5% of the sustained severe range blood pressures were treated with short-acting antihypertensives. These data suggest pathways to target for quality measures to improve management of postpartum hypertension.View Large Image Figure ViewerDownload Hi-res image Download (PPT)