Clinical characteristics and subsequent need for anti-hypertensive agents in the postpartum period for hypertensive disorders of pregnancy.

Abstract

The objective of this study was to identify clinical characteristics of patients with hypertensive disorders of pregnancy associated with requiring multiple anti-hypertensive medications to optimize blood pressure in the postpartum setting. We performed a retrospective cohort study of all women who had a diagnosis of hypertensive disorders of pregnancy who delivered at a single institution between October 1, 2017 and May 1, 2021. Demographics and clinical characteristics including category of anti-hypertensive medication and number of medications were collected. Models were adjusted for race. A total of 1,708 women were identified for inclusion. Of this cohort, 64.9% did not require any anti-hypertensive medications, while 24.8% used one medication and 10.2% required two or more medications. When comparing women by the number of medications that were required, their demographics were similar except for race (p<0.001). Women taking two or more medications were most prescribed a beta blocker (94.9%) followed by a calcium channel blocker (88.6%). Women with a history of chronic hypertension had the highest risk of requiring two or more medications for blood pressure control (adjusted RR 11.19, 95% CI 2.63-47.60). Chronic kidney disease also significantly increased the risk of requiring two or more medications (adjusted RR 3.09, 95% CI 1.24-7.69). Women with chronic hypertension and chronic kidney disease are at increased risk for requiring multiple anti-hypertensive medications in the postpartum setting. We recommend frequent postpartum visits, either in person or implementing telemedicine platforms to optimize blood pressure control for this high-risk cohort.