Postpartum Hypertension Research Articles

Postpartum Readmission for Hypertension: The Patient Experience [ID: 1377602

INTRODUCTION: Hypertensive disorders of pregnancy (HDP) are the most common cause of postpartum readmission. Prior research has led to the creation of clinical guidelines for postpartum management; however, the patient experience is often missing from this work. The objective of this project is to understand the perspective of patients readmitted for postpartum hypertension. METHODS: Institutional review board committee approval was obtained for the study. This was a qualitative study with data generated through semistructured interviews. Patients readmitted with postpartum HDP at an urban academic medical center were approached and consented for a single interview. The same researcher conducted all interviews and patient recruitment continued until thematic saturation was reached (n=9). Two coders coded all interviews using NVivo software with both deductive and inductive coding processes. Discrepancies were discussed and resolved with consensus. Researchers identified themes through grounded theory and were reflexive in their thematic generation. RESULTS: Five themes were generated through the grounded theory analysis: Every pregnancy is different, symptoms of preeclampsia are easily dismissed or often not taken seriously, miscommunication regarding medical changes can hinder patient care, readmission logistics are not baby-friendly, and patient well-being improved when conversations acknowledged the struggles of readmission. CONCLUSION: A qualitative research process revealed patient-identified gaps in care that may have led to readmission for HDP. The specific recommendations that emerge from these themes include: addressing barriers to blood pressure management prior to discharge, improving postpartum discharge follow-up, providing newborn care coordination, and improving counseling on the risk of postpartum preeclampsia during discharge. Incorporating these patient perspectives in hospital discharge policy can be helpful in creating patient-centered systems of care and may help reduce rates of readmission.

Red ginger (Zingiber officinale var. rubrum) nanoparticle extracts on reducing the blood pressure for postpartum hypertension

Background: Red ginger contains flavonoids, which can cause vasodilation and decreased cardiac output and pressure. Previous research on red ginger on blood pressure has been carried out and showed significant results. However, it has yet to be studied in nanoparticle extracts, where nanoparticles are the best drug carrier system, so it is necessary to research.Purpose: Making and testing red ginger nanoparticle administration (Zingiber officinale var. rubrum) to reduce blood pressure in hypertensive postpartum mothers.Methods: This is an experimental study with a pre-post control group design. The sample consisted of 40 postpartum hypertensive mothers divided into two groups, namely 20 interventions and 20 controls. The intervention group was given red ginger nanoparticles made using the bottom-up method with a dose of 300 mg and the antihypertensive drug nifedipine, while the control group was given the antihypertensive drug nifedipine alone; both were given for two weeks. Data analysis used the Independent t-test and reapeted ANOVA tests.Results: The systolic blood pressure in the intervention group decreased by 12.95 mmHg on the 7th and 28.4 mmHg on the 14th day (p<0.001) while the control group was 7.05 mmHg on the 7th day and 14.8 mmHg on the 14th day (p<0.001). Diastolic blood pressure in the intervention group decreased by 3.55 mmHg on the 7th day and 11.90 mmHg on the 14th day (p<0.001), while the control group was 2.88 mmHg on the seventh day (p<0.007) and fifth day 35 mmHg on day 14 (p<0.002).Conclusion: Giving red ginger nanoparticles can reduce blood pressure in postpartum hypertension

Effectiveness of extended postpartum inpatient monitoring for hypertensive disorders of pregnancy to reduce the risk of readmission for preeclampsia with severe features

Preeclampsia is an obstetrical disorder, which complicates 3% to 6% of pregnancies and contributes to 21.6% of readmissions in the postpartum period. The optimal strategy for inpatient monitoring of blood pressures to minimize readmissions for postpartum patients with hypertensive disorders is not known. We hypothesized that extended monitoring of postpartum patients with hypertensive disorders of pregnancy for at least 36 hours after the last blood pressure that was ≥150/100 mm Hg would result in decreased readmission rates for preeclampsia with severe features compared with those who were not observed by these blood pressure goals. This study aimed to evaluate whether extended inpatient monitoring of postpartum patients with hypertensive disorders of pregnancy for at least 36 hours after their last blood pressure that was ≥150/100 mm Hg would improve readmission rates for preeclampsia with severe features within 6 weeks of delivery. This was a retrospective cohort study in patients with a singleton pregnancy and a diagnosis of a hypertensive disorder of pregnancy at their delivery admission or at any point during pregnancy who delivered 1 year before and 1 year after the implementation of extended inpatient monitoring of postpartum hypertension. The primary outcome was readmission for preeclampsia with severe features within 6 weeks of delivery. The secondary outcomes were length of stay during first admission, number of readmissions for any indication, intensive care unit admission, postpartum day at readmission, median systolic blood pressure in the 24-hour period before discharge, median diastolic blood pressure in the 24-hour period before discharge, intravenous antihypertensive medication required during first admission, and intravenous antihypertensive medication required during second admission. Univariable analysis was performed for the association between baseline maternal characteristics and the primary outcome. Multivariable analysis was performed, adjusting for baseline maternal characteristic differences between exposure groups. A total of 567 patients met the inclusion criteria of which 248 patients delivered before and 319 delivered after the implementation of extended monitoring. For baseline characteristics, the extended monitoring group had a significantly higher proportion of patients who were non-Hispanic Black and Hispanic, more diagnoses of hypertensive disorders and/or diabetes mellitus at the time of admission for delivery, a difference in the distribution of hypertensive diagnoses at the time of discharge from the first admission, and fewer discharged patients from their first admission on labetalol than the preintervention group. In a univariable analysis of the primary outcome, there was a significantly increased risk of readmission for preeclampsia with severe features in the extended monitoring group (62.5% vs 96.2% of total readmissions; P=.004). In multivariable analysis, patients in the extended monitoring group were more likely to be readmitted for preeclampsia with severe features than patients in the preintervention group (adjusted odds ratio, 3.45; 95% confidence interval, 1.03-11.5; P=.044). Extended monitoring with a strict blood pressure goal of <150/<100 mm Hg did not decrease readmissions for preeclampsia with severe features in patients with a previous diagnosis of a hypertensive disorder of pregnancy.

Self-management system for postpartum women with hypertension disorders: an eHealth application intervention study

BackgroundHypertension disorders are relatively common in pregnant women and often persist in the postpartum period. Few studies are available regarding the self-management of postpartum hypertension via the eHealth system. This study aimed to develop a self-management eHealth system for women with postpartum hypertension during the postpartum period.MethodsWe adopted a multi-platform system for this research, not only for use on the web interface but also on smartphones. The proposed system possessed three features: (1) the population was limited to postnatal women with hypertension; (2) a self-care record, which allowed postnatal women to keep track of their blood pressure, pulse, weight, medication record, exercise record, and risk factor assessment; and (3) through this system, nurse-midwives could keep track of postnatal women’s health status maintaining the complete record and could communicate directly with the users if their health monitor values reach beyond normal range.ResultsThirty-nine postnatal women with postpartum hypertension were recruited to the study. A survey to evaluate the usability and satisfaction of the proposed e-health application system was completed by these women. The usability rate of the system reached 92.4% (46.2% satisfied and 46.2% strongly satisfied), which suggested that the system was helpful to the users. The satisfaction rate of the system reached 94.9% (43.6% satisfied and 51.3% strongly satisfied), which suggested that the system was acceptable to the users.ConclusionThis proposed system has been developed completely with user experience and professional advice from experts. Postnatal women could gain important postpartum-related knowledge and access their related health records and other information easily via their smartphones or computers. During the postpartum period, an eHealth application system can effectively assist women with hypertension to manage their blood pressure and related postnatal healthcare issues.

Identifying Targets to Improve the Management of Severe Hypertension in Pregnancy and Postpartum

ObjectivesTo (1) define quality indicators, (2) describe care gaps, and (3) identify process issues in severe hypertension (sustained systolic blood pressure [BP] ≥160 mm Hg or diastolic BP ≥110 mm Hg) management at our tertiary care centre. MethodsPregnant and postpartum persons diagnosed with a hypertensive disorder of pregnancy from 2018 to 2019 were identified. A retrospective cohort of patients with severe hypertension was constructed, and data were collected through chart review. Severe hypertension management was assessed according to defined quality indicators. Clinical characteristics were compared between participants with and without time-to-target BP within 60 minutes. Process issues were examined for each severe hypertension occurrence. ResultsOf 608 participants with a hypertensive disorder of pregnancy, 90 (15%) experienced severe hypertension. Median time-to-target BP was 76 minutes (interquartile range 47–123 minutes), and target BP (<155/105 mm Hg) was achieved within 60 minutes in 31/90 (34%) participants. Appropriate antihypertensives for severe hypertension were used in 55/90 (61%), and time-to-treatment initiation was within 30 minutes in 42/54 (78%). Chronic hypertension and oral labetalol use were associated with delays in achieving target BP. Process issues related to severe hypertension management included inappropriate treatment (n = 35/90; 39%), failure to recognize severe hypertension as an emergency (n = 21/90; 23%), and delayed treatment initiation (n = 12/54; 22%). ConclusionWe defined quality indicators for severe hypertension management. Time-to-target BP within 60 minutes was achieved in a minority of patients, and chronic hypertension was associated with delayed severe hypertension resolution. Process issues in severe hypertension management were described.

Redesigning Care for the Management of Postpartum Hypertension: How Can Ob-Gyns and Primary Care Physicians Partner in Caring for Patients after a Hypertensive Pregnancy?

The standard care model in the postpartum period is ripe for disruption and attention. Hypertensive disorders of pregnancy (HDPs) can continue to be a challenge for the postpartum person in the immediate postpartum period and is a harbinger of future health risks. The current care approach is inadequate to address the needs of these women. We propose a model for a multidisciplinary clinic and collaboration between internal medicine specialists and obstetric specialists to shepherd patients through this high-risk time and provide a bridge for lifelong care to mitigate the risks of a HDP. KEY POINTS: · HDPs are increasing in prevalence.. · The postpartum period can be more complex for women with HDPs.. · A multidisciplinary clinic could fill the postpartum care gap for women with HDP..

Clinical characteristics and sequelae of intrapartum hypertension – a retrospective cohort study

BackgroundIn a significant proportion of pregnant women, elevated blood pressure may first present during the intrapartum period. This phenomenon, intrapartum hypertension, is often overlooked as blood pressure during delivery is attributed to labour pain, analgesic agents and haemodynamic changes. Thus the true prevalence and clinical significance of intrapartum hypertension remains unknown. This study sought to define the prevalence of intrapartum hypertension in previously normotensive women, identify associated clinical characteristics, and its impact on maternal and fetal outcomes.MethodsIn this single-center retrospective cohort study, all available partograms were reviewed over a 1-month period at an outer metropolitan hospital in Sydney (Campbelltown Hospital). Women with diagnosed hypertensive disorders of pregnancy during the incident pregnancy were excluded. A total of 229 deliveries were included in the final analysis. Intrapatum hypertension (IH) was defined as two or more systolic blood pressure (SBP)⩾140 mmHg or diastolic blood pressure (DBP)⩾90 mmHg during the intrapartum. Demographic data at the time of the first antenatal visit for the incident pregnancy as well as final maternal outcomes (intrapartum and post-partum) and fetal outcomes were collected. Statistical analyses were carried out using SPSSv27 with adjustments for baseline variables.ResultsAmongst 229 deliveries, 32 women (14%) had intrapartum hypertension. Older maternal age (p = 0.02), higher body mass index (p < 0.01) and higher diastolic blood pressure at the first antenatal visit (p = 0.03) were associated with intrapartum hypertension. A longer second stage of labour (p = 0.03), intrapartum non-steroidal anti-inflammatory medications (p < 0.01) and epidural anaesthesia (p = 0.03) were associated with intrapartum hypertension, while IV syntocin for labour induction was not. Women with intrapartum hypertension had a longer inpatient admission following delivery (p < 0.01), and elevated postpartum BP (p = 0.02) with discharge on antihypertensive medications (p < 0.01). Intrapartum hypertension was not associated with poor fetal outcomes, though subgroup analyses showed that women who had at least a single elevated blood pressure reading during the intrapartum experienced poorer fetal outcomes.ConclusionIn previously normotensive women, 14% developed intrapartum hypertension during delivery. This was associated with postpartum hypertension, longer maternal admission and discharge with antihypertensive medications. There was no difference in fetal outcomes.

IDF2022-0499 The association between maternal glucose levels in pregnancy and post-partum hypertension

IDF2022-0499 The association between maternal glucose levels in pregnancy and post-partum hypertension

Third-Trimester Maternal Serum Chemerin and Hypertension After Preeclampsia: A Prospective Cohort Study.

Background Limited data are available for postpartum hypertension prediction after preeclampsia. Methods and Results We examined the association between maternal serum chemerin levels in patients with preeclampsia and blood pressure (BP) levels after delivery in a prospective birth cohort of 15 041 singleton pregnant women. A total of 310 cases among 322 patients with preeclampsia (follow-up rate, 96.3%) were followed up during a mean 2.8 years after delivery. Compared with matched uncomplicated controls (n=310), serum chemerin measured at ≈35 gestational weeks was significantly increased in preeclampsia (171.8±49.2 versus 140.2±53.5 ng/mL; P<0.01) and positively correlated with the occurrence of postpartum hypertension, defined as either BP ≥130/80 mm Hg (per 1-SD increase: odds ratio [OR], 4.01 [95% CI, 2.77-5.81]) or as BP ≥140/90 mm Hg (per 1-SD increase: OR, 1.70 [95% CI, 1.28-2.25]) in patients with preeclampsia. The addition of chemerin levels improved the predictive performance of the clinical variable-derived prediction models for postpartum hypertension (for BP ≥130/80 mm Hg: area under the curve, 0.903 [95% CI, 0.869-0.937], Δ area under the curve, 0.070, P<0.001; for BP ≥140/90 mm Hg: area under the curve, 0.852 [95% CI, 0.803-0.902], Δ area under the curve, 0.030, P=0.002). The decision curve analysis revealed a net benefit of the chemerin-based prediction model for postpartum BP ≥130/80 mm Hg. Conclusions This study provides the first evidence supporting the independent predictive role of third-trimester maternal chemerin levels for postpartum hypertension after preeclampsia. Future study is warranted for external validation of this finding.

JAHA Go Red for Women Spotlight 2023.

JAHA Go Red for Women Spotlight 2023.

Smooth Muscle Mineralocorticoid Receptor Promotes Hypertension After Preeclampsia.

Preeclampsia is a syndrome of high blood pressure (BP) with end organ damage in late pregnancy that is associated with high circulating soluble VEGF receptor (sFlt1 [soluble Fms-like tyrosine kinase 1]). Women exposed to preeclampsia have a substantially increased risk of hypertension after pregnancy, but the mechanism remains unknown, leaving a missed interventional opportunity. After preeclampsia, women have enhanced sensitivity to hypertensive stress. Since smooth muscle cell mineralocorticoid receptors (SMC-MR) are activated by hypertensive stimuli, we hypothesized that high sFlt1 exposure in pregnancy induces a postpartum state of enhanced SMC-MR responsiveness. Postpartum BP response to high salt intake was studied in women with prior preeclampsia. MR transcriptional activity was assessed in vitro in sFlt1-treated SMC by reporter assays and PCR. Preeclampsia was modeled by transient sFlt1 expression in pregnant mice. Two months post-partum, mice were exposed to high salt and then to AngII (angiotensin II) and BP and vasoconstriction were measured. Women exposed to preeclampsia had significantly enhanced salt sensitivity of BP verses those with a normotensive pregnancy. sFlt1 overexpression during pregnancy in mice induced elevated BP and glomerular endotheliosis, which resolved post-partum. The sFlt1 exposed post-partum mice had significantly increased BP response to 4% salt diet and to AngII infusion. In vitro, SMC-MR transcriptional activity in response to aldosterone or AngII was significantly increased after transient exposure to sFlt1 as was aldosterone-induced expression of AngII type 1 receptor. Post-partum, SMC-MR-KO mice were protected from the enhanced response to hypertensive stimuli after preeclampsia. Mechanistically, preeclampsia mice exposed to postpartum hypertensive stimuli develop enhanced aortic stiffness, microvascular myogenic tone, AngII constriction, and AngII type 1 receptor expression, all of which were prevented in SMC-MR-KO littermates. These data support that sFlt1-induced vascular injury during preeclampsia produces a persistent state of enhanced sensitivity of SMC-MR to activation. This contributes to postpartum hypertension in response to common stresses and supports testing of MR antagonism to mitigate the increased cardiovascular risk in women after PE.

Oral combined hydrochlorothiazide and lisinopril vs nifedipine for postpartum hypertension: a comparative-effectiveness pilot randomized controlled trial

Angiotensin-converting enzyme inhibitors and diuretics may be underutilized for postpartum hypertension because of their teratogenicity during pregnancy. We evaluated whether combined oral hydrochlorothiazide and lisinopril therapy produced superior short-term blood pressure control when compared with nifedipine among postpartum individuals with hypertension requiring pharmacologic treatment. We performed a pilot randomized controlled trial (October 2021 to June 2022) that included individuals with chronic hypertension or hypertensive disorders of pregnancy with 2 systolic blood pressure measurements ≥150 mm Hg and/or diastolic blood pressure measurements ≥100 mm Hg within 72 hours after delivery. Participants were randomized to receive either combined hydrochlorothiazide and lisinopril therapy or nifedipine therapy after stratifying the participants by diagnosis (chronic hypertension vs hypertensive disorders of pregnancy). The primary outcome was stage 2 hypertension (systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg) determined using a home blood pressure monitor on days 7 to 10 after delivery or at readmission to the hospital for blood pressure control. The secondary outcomes included severe maternal morbidity (any of the following: intensive care unit admission; hemolysis, elevated liver enzymes, low platelet count syndrome; eclampsia; stroke; cardiomyopathy; or maternal death), need for intravenous medications after randomization, hospital length of stay, blood pressure during first clinic visit, medication compliance, and adverse events. A pilot trial with 70 individuals was planned given the limited available data on combined hydrochlorothiazide and lisinopril therapy use in postpartum care. We calculated relative risks and 95% credible intervals in an intention-to-treat analysis. Finally, we conducted a preplanned Bayesian analysis to estimate the probability of benefit or harm with a neutral informative prior. Of 111 eligible individuals, 70 (63%) agreed and were randomized (31 in the hydrochlorothiazide and lisinopril group and 36 in the nifedipine group; 3 withdrew consent after randomization), and the characteristics were similar at baseline between the groups. The primary outcome was unavailable for 9 (12.8%) participants. The primary outcome occurred in 27% of participants in the hydrochlorothiazide and lisinopril group and in 43% of the participants in the nifedipine group (posterior adjusted relative risk, 0.74; 95% credible interval, 0.40-1.31). Bayesian analysis indicated an 85% posterior probability of a reduction in the primary outcome with combined hydrochlorothiazide and lisinopril therapy relative to nifedipine treatment. No differences were noted in the secondary outcomes or adverse medication events. The results of the pilot trial suggest a high probability that combined hydrochlorothiazide and lisinopril therapy produces superior short-term BP control when compared with nifedipine. These findings should be confirmed in a larger trial.

De Novo Postpartum Hypertension: Incidence and Risk Factors at a Safety-Net Hospital.

Postpartum hypertension can be persistent, following a pregnancy complicated by hypertension, or new onset (de novo), following a normotensive pregnancy. The aim of this study is to estimate the incidence and identify risk factors for de novo postpartum hypertension (dn-PPHTN) among a diverse safety-net hospital population. We conducted a retrospective cohort study of 3925 deliveries from 2016 to 2018. All blood pressure (BP) measures during pregnancy through 12 months postpartum were extracted from medical records. Patients with chronic hypertension or hypertensive disorders of pregnancy were excluded. dn-PPHTN was defined as 2 separate BP readings with systolic BP ≥140 mm Hg and diastolic BP ≥90 mm Hg at least 48 hours after delivery. Severe dn-PPHTN was defined as systolic BP ≥160 and diastolic BP ≥110. We examined risk factors individually and in combination and timing of diagnosis. Among the 2465 patients without a history of hypertension, 12.1% (n=298) developed dn-PPHTN; 17.1% of whom had severe dn-PPHTN (n=51). Compared to those without dn-PPHTN; cases were more likely to be ≥35 years, delivered via cesarean, or be current or former smokers. Patients with all of these characteristics had a 29% risk of developing dn-PPHTN, which was elevated among non-Hispanic Black patients (36%). Approximately 22% of cases were diagnosed after 6 weeks postpartum. More than 1 in 10 patients with normotensive pregnancies experience dn-PPHTN in the year after delivery. Opportunities to monitor and manage patients at the highest risk of dn-PPHTN throughout the entire year postpartum could mitigate cardiovascular related maternal morbidity.

Postpartum Discharge on Labetalol was Associated with Increase Risk of Readmission for Hypertension Compared with Discharge on Nifedipine

Introduction: Hypertension complicating pregnancy is common and, when uncontrolled, can have devastating consequences. Objectives: The main objective of the study is to find the postpartum discharge on labetalol was associated with increase risk of readmission for hypertension compared with discharge on nifedipine. Material and methods: This cross-sectional study was conducted in Islam medical college and teaching hospital Sialkot during June 2022 to September 2022. The data was collected with the permission of ethical committee of hospital. Data was collected with the permission of ethical committee of hospital. Participants were randomized to labetalol versus extended release nifedipine using a computerized random number generator. Results: Data was collected from 50 female patients. Baseline maternal characteristics were similar between groups, including age, race, body mass index (BMI), gravidity and parity, rate of twins, and presence of medical comorbidities including chronic hypertension. Data was collected in two groups, one group of labetalol and second group of nifedipine. Practical implication: This study will help us to find the efficacy of both the drugs that we used in the study for the purpose of postpartum hypertension. Conclusion: It is concluded that both oral labetalol and oral extended release nifedipine are effective and well tolerated for management of postpartum hypertension. Keywords: Hypertension, Postpartum, Oral, Management, Labetalol, Nifedipine

Implementation of maternal guidelines for gravid teenagers with hypertensive disorders in KwaZulu-Natal.

The worldwide phenomenon of teenage pregnancy among 13-9-year-olds is complicated by obstetric conditions. Among the top three causes of maternal mortality, hypertension is the third in South Africa. Quality maternal care is assured by obstetric practitioners (OPs) implementing guidelines specific for management of hypertension in pregnancy. The objective of this study was to investigate implementation of maternal guidelines for hypertension in pregnancy among teenagers. As a retrospective quantitative research design was used, 173 maternal records of pregnant teenagers from 13 to 19 years were sampled from six district hospitals and Community Health Centres (CHCs) between 01 January 2017 and 31 December 2019 to undergo systematic random sampling. A pretested structured checklist was used to record data from sampled maternal records. Statistical Package for Social Sciences (SPSS) version 26 was used for data analysis, and results were presented using simple descriptive statistics. Research results indicated that teenagers who suffered from hypertension intrapartum and postpartum did not receive maternal care according to the guidelines for maternity care in South Africa. Blood pressure was not measured of six (3.47%) intrapartum and five (2.9%) postpartum teenagers. Seventeen (9.8%) hypertensive postpartum teenagers received their antihypertensives. Public health institutions (PHIs) compromised provision of quality maternal care among teenagers, evidenced by incomplete intrapartum and postpartum assessment, diagnosis and management of hypertensive disorders in pregnancy (HDP).Contribution:This study contributed to facilitating adherence to guidelines improving healthcare of teenagers in government facilities.

A standardized clinical assessment and management plan (SCAMP) reduces readmissions in postpartum hypertension

Postpartum hypertension is one of the most frequent reasons for emergency department (ED) visits and readmission. We aimed to evaluate the effect of a SCAMP on these metrics in the postpartum period. We conducted a prospective cohort study of patients with postpartum hypertension at a tertiary care center for 3 months before and after enacting a SCAMP. The prospective group (P) were compared with historical controls (C). Elements of the SCAMP included 1) initiation or uptitration of medication for any blood pressure (BP) >150/100 or 2 BPs >140/90 within a 24hr period with goal of achieving normotension and 2) enrollment in outpatient virtual BP monitoring with close follow-up by the study team on discharge. Primary outcome was postpartum ED visit or readmission. Secondary outcomes were medication side effects, hypotension, utilization of the BP monitoring system, and length of stay (LOS). Chi-square, t-test, and Mann-Whitney U test were used as appropriate to compare groups. IRB#14-001098. 176 patients in (P) cohort were compared to 156 historical controls (C). The primary outcome of ED visits significantly decreased from 7.69% (C) to 1.13% (P) (p=0.003), and readmission rates decreased from 7.05% (C) to 1.70% (P) (p=0.02). When combined, the rate of patients who had either an ED visit or readmission decreased from 14.74% (C) to 3.21% (P) (p< 0.001). More patients were prescribed anti-hypertensives on discharge in (P) cohort (33.0% P vs 21.8% C, p=0.02), of whom 3 (5.2%) had hypotension (BP < 100/60) and 4 (6.9%) had side effects. The (P) cohort had longer mean postpartum LOS that was statistically significant (2.4 1.0 days P vs 2.1 1.0 days C, p=0.04). Total 100 (56.8%) patients were compliant with virtual BP monitoring, with 18 (18%) medication adjustments made per protocol. Utilizing a SCAMP encompassing strict BP control in the postpartum period followed by intensive outpatient follow-up can significantly reduce postpartum ED visits and readmissions.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Furosemide for the prevention of de novo postpartum hypertension: A randomized placebo-controlled trial

Furosemide for the prevention of de novo postpartum hypertension: A randomized placebo-controlled trial

Identifying new onset postpartum hypertension in a low risk population using remote blood pressure monitoring

Identifying new onset postpartum hypertension in a low risk population using remote blood pressure monitoring

Oral combined hydrochlorothiazide/lisinopril versus nifedipine for postpartum hypertension: a comparative-effectiveness pilot randomized controlled trial

Angiotensin-converting enzyme inhibitors and diuretics may be underutilized for postpartum hypertension (HTN). In this pilot randomized trial, we evaluated whether oral combined hydrochlorothiazide/lisinopril (HCTZ/lisinopril) produces superior short-term blood pressure (BP) control compared to nifedipine among postpartum individuals with HTN requiring pharmacologic treatment. Individuals with chronic HTN (CHTN) or hypertensive disorder of pregnancy (HDP) with two measurements of systolic BP (SBP) ≥150 and/or diastolic BP (DBP)≥ 100 within 72 hours after delivery were randomized to either HCTZ/lisinopril or nifedipine after stratifying by diagnosis (CHTN vs HDP). The primary outcome was stage 2 HTN (SBP≥140 and/or DBP ≥90) using a home BP monitor on days 7-10 after delivery or readmission to the hospital for BP control. A pilot trial with 70 individuals was planned, given limited previous data on HCTZ/lisinopril use in postpartum care. We calculated relative risk (RR) and 95% confidence intervals (CI) in an intention-to-treat analysis and conducted a preplanned Bayesian analysis to estimate the probability of benefit or harm with a neutral informative prior. ClinicalTrials.gov: NCT05049616 Of 111 eligible individuals (10/2021 to 06/2022), 70 (63%) agreed and were randomized, with no significant differences at baseline between groups (Table 1). The primary outcome was unavailable for 12 (17%) participants. The primary outcome occurred in 27% in the HCTZ/lisinopril group compared to 43% in the nifedipine group (posterior adjusted RR, 0.74, 95% credible interval, 0.40-1.31) (Table 2). Bayesian analysis indicated an 85% posterior probability of reduced primary outcome with HCTZ/lisinopril relative to nifedipine. No differences were noted in secondary outcomes or medication adverse events. In this pilot study, our results suggest a high probability that HCTZ/lisinopril produces superior short-term BP control compared to nifedipine. These findings should be confirmed in a larger trial.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Postpartum furosemide and rates of readmission in women with hypertensive disorders of pregnancy

Hypertensive disorders of pregnancy (HDP) remain a primary driver of maternal postpartum readmission and a cause of maternal mortality; however, the optimal pharmacological approach to management of postpartum hypertension has not been established.