883 Racial disparities in utilization of oral anti-hypertensives in the postpartum period

Abstract

Hypertensive disorders of pregnancy (HDP) carry disproportionate morbidity and mortality for black women particularly in the postpartum (PP) period. Currently, there are no standardized protocols for PP hypertension (HTN) other than standard recommendations to treat severe range blood pressures (≥160/110 mmHg). Our objective was to assess the proportion of women with persistent PP HTN treated with oral antihypertensive agents and to determine if this differs by race. We performed a retrospective cohort study that included women with a HDP (chronic HTN, superimposed preeclampsia, preeclampsia, eclampsia and gestational HTN) who delivered between 1/2017-9/2019 at Magee-Womens Hospital of the University of Pittsburgh Medical Center (UPMC). Our primary outcome was the proportion of women with persistent HTN discharged on an oral antihypertensive agent. Women were considered to have persistent HTN if they had 2 or more BPs of ≥150/100 mmHg at least 4 hours apart during the inpatient PP hospitalization. We identified eligible women utilizing data collected through UPMC’s Clinical Analytics Department. Demographic and obstetric outcomes were stratified by self-reported race. We identified 652 women diagnosed with a HDP with persistent PP HTN while inpatient; 215 (33%) black women and 437 (67%) women of other races. In all, 63% of women with HDP with persistent PP HTN were discharged on oral antihypertensive agents. There was no difference by race in the utilization of oral antihypertensives prior to discharge (62.3% of black women vs. 63.6% of other race, p=0.70). Among a subset of our cohort enrolled in a home BP management program (n=258), an additional 17.0% of women were initiated on oral anti-hypertensive agents after hospital discharge. Among women with persistent PP HTN, 63% were discharged on oral anti-hypertensive agents. In our cohort, use of oral antihypertensive medication during the inpatient PP hospitalization did not differ by race. Further investigation of appropriate BP parameters for initiation of oral antihypertensive agents in the PP period is needed.View Large Image Figure ViewerDownload Hi-res image Download (PPT)