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The myriad rehospitalizations required by women with ongoing hypertension in the postpartum period signaled a need to better manage these patients, researchers said.

Among people with new-onset hypertensive disorder of pregnancy (HDP), 81.8% had persistent hypertension postpartum after hospital discharge -- 14.1% severe hypertension -- based on one hospital system's remote blood pressure (BP) monitoring data.

Compared with peers whose BP normalized after discharge, those with severe hypertension postpartum were more likely to have hospital readmissions (adjusted OR 6.75, 95% CI 3.43-13.29) and emergency department visits (adjusted OR 1.85, 95% CI 1.17-2.92) within the first 6 weeks postpartum, reported a group led by Alisse Hauspurg, MD, MS, of University of Pittsburgh School of Medicine in Pennsylvania.

Postdischarge BP trajectories were largely similar between those with inpatient BPs of 140-149/90-99 mmHg and ≥150/100 mmHg, the authors reported in .

"Given new, compelling data supporting the importance of adequate BP control during the critical window of the immediate postpartum period for longer-term maternal health, our findings reinforce the critical role of remote BP monitoring in the postpartum period and suggest the need for further research to develop effective BP thresholds for antihypertensive medication initiation in the postpartum period," Hauspurg's group wrote.

Hypertensive disorders of pregnancy (e.g., preeclampsia, eclampsia, gestational hypertension) per year, according to the CDC. Advanced maternal age, obesity, and diabetes are among the risk factors for these hypertensive disorders, which in turn can cause heart attacks and strokes in pregnant women.

The American College of Cardiology (ACC) and American Heart Association (AHA) state BP measurements of ≥140/90 mmHg on at least two occasions as criteria for medication initiation, whereas the American College of Obstetricians and Gynecologists (ACOG) have a higher threshold of ≥150/100 mm Hg on two occasions.

The question is whether lower thresholds for antihypertensive medication initiation during the inpatient delivery hospitalization might help women in the immediate period after giving birth. The optimal threshold is not known given the lack of evidence from randomized trials in the postpartum period, study authors noted, adding that there are no guidelines for specific antihypertensive agents nor parameters for medication titration.

The present report showed that women with nonsevere persistent hypertension postpartum did not have significant links to hospital readmissions and emergency visits at the 6-week mark.

Study authors did strongly suggest remote BP monitoring, citing the POP-HT trial in which a self-managed, physician-guided telemonitoring program lowered postpartum BP at 6-9 months following a hypertensive pregnancy.

How frequently BP monitoring postpartum should be done is unclear, however, commented JAMA Cardiology editor Sadiya Khan, MD, MSc, of Northwestern University Feinberg School of Medicine in Chicago, writing in an .

At Hauspurg's institution, patients were enrolled in a remote BP monitoring and management program by their primary obstetric practitioner while inpatient on the postpartum unit. Each patient received an upper arm BP monitor, which they were trained on how to use so they could report BP measurements regularly via text messaging to a nurse-staffed call center. A physician reviewed measurements and initiated or titrated antihypertensive medications based on clinical judgement.

"Our findings highlight the need for improvement in postpartum BP management in individuals with new-onset HDP. Despite our robust postpartum hypertension management program, the majority of individuals in our cohort had ongoing hypertension after discharge from the delivery hospitalization," Hauspurg and colleagues wrote.

The present study arose as a part of the University of Pittsburgh Medical Center Hospital System's quality improvement efforts and was a population-based sample of individuals with gestational hypertension, preeclampsia, eclampsia, or new-onset postpartum hypertension who delivered between September 2019 and June 2021. Postpartum individuals with prepregnancy chronic hypertension or who were enrolled during a postpartum readmission were excluded.

The study included 2,705 people (mean age 29.8 years), 18% identifying as Black and around 35% reporting use of public insurance at the delivery admission.

Postpartum, 53.9% were not treated with antihypertensive medications, while 23.5% were discharged with them and 22.6% had the medications initiated after hospital discharge (the latter at a median 7 days postpartum). Only 14.6% of those discharged with antihypertensive drugs achieved outpatient BP control postpartum.

"[T]he discordance between the ACC/AHA and ACOG criteria for targets representing optimal control of BP may be a major contributor to the observed heterogeneity in antihypertensive management strategies, and, subsequently, greater risk of readmission due to uncontrolled or severe hypertension," Khan commented.

Whether findings are generalizable to other centers and patients remains questionable, according to Hauspurg and colleagues. In addition, they cautioned that they had based the study on self-reported BPs.

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