181 Persistent postpartum hypertension: are we missing something? A retrospective cohort study

Abstract

Despite the prevalence of hypertensive disorders of pregnancy (HDP), the true pathophysiology postpartum remain uncertain. We sought to identify risk factors associated with persistent postpartum hypertension (HTN) in patients diagnosed with HDP prior to delivery. We performed a retrospective cohort study of patients with HDP at a single tertiary center between January 1, 2015 and December 31, 2017. Patients with HDP were assessed for elevated blood pressure (>/=140/90) occurring within six weeks following delivery. Those with elevated blood pressure (BP) postpartum were compared to normotensive patients in the same cohort. Medical records were reviewed for: delivery gestational age, maternal age, parity, diagnosis, race, BMI, tobacco use, average BP at hospital discharge, requirement of antihypertensive (antiHTN) medication at discharge, pregnancy weight gain, postpartum weight loss, requirement of intrapartum or postpartum acute antiHTN treatment. A p-value of <0.05 indicated statistical significance. There were 321 patients diagnosed with HDP during the study period. Compared to postpartum normotensive counterparts (n=202), women with persistent HTN in the postpartum period (n=119) were significantly more likely to be older (26.5 vs 24.3 years, p<0.0001), have a parity of >/=5 (21.8% vs 11.9%, p=0.02), have a diagnosis of preeclampsia with severe features including eclampsia (63.8% vs 43.6%, p=0.002), be discharged with an average BP >/=140/90 (49.6% vs 27.2%, p<0.0001), be discharged on antiHTN medication (40.3% vs 18.8%, p<0.0001), and have required treatment of severe range BP intrapartum (40.3% vs 25.7%, p=0.007) or postpartum (45.3% vs 24.7%, p=0.0002). Our investigation revealed significant risk factors associated with persistent postpartum HTN amongst patients with HDP. Greater understanding of these associated risk factors will not only lead to a greater understanding of the pathophysiology of the disease but also aid in improving surveillance and management strategies. Our study suggests close postpartum monitoring of women with risk factors is warranted.