387. Postnatal hypertension – What do women want?

Abstract

Hypertensive disorders often persist or arise de novo in the postpartum period and there is a lack of robust evidence to guide therapy. Current first line antihypertensives used antenatally require multiple daily doses, which may cause issues with compliance postnatally. This in part, explain the increase in the complications such as eclampsia and intracerebral haemorrhage occurring after delivery. Understand prescribing habits, adherence and patient views on antihypertensive use in women with postpartum hypertension. We undertook a prospective cross sectional study at Whipp’s Cross Hospital between January and April 2018. Women with postpartum hypertension, requiring medication, were included and questioned at discharge and then again at 2 weeks postpartum. Demographics, obstetric and medication history were all recorded, along with self-reported adherence. Thirty-six women with a mean age of 32 (±4.6) years were included in the study. The commonest cause of postpartum hypertension was pre-eclampsia (64%) and on discharge labetolol was the most commonly prescribed therapy (50%) with one third of patients requiring combination therapy. At discharge only 5 patients (14%) correctly reported their prescription and dosage regime, despite this half of the cohort predicted they would be “likely” or “very likely” to remember to take medication regularly. At two weeks postpartum 57% admitted to forgetting their medication on up to 3 occasions, with only 40% reporting no missed doses. Ninety-five percent of patients now stated a preference for once daily medication, compared to 69% when questioned at discharge. The majority of mothers prior to discharge do not have a clear idea of their antihypertensive regime, which is often combination therapy, but predict that they will not have any issues. The reality at two weeks postpartum is the majority have missed doses and now would almost all favour a more simpler once daily dosing regimen.