Best Practices for Managing Postpartum Hypertension

Abstract

Purpose of Review Patients remain at risk for persistent and de novo postpartum hypertension related to pregnancy. This review aims to summarize the current definitions, clinical practices, and novel systems innovations and therapies for postpartum hypertension. Recent Findings Recent changes to the definitions of hypertension outside of pregnancy have not yet impacted definitions or management of hypertensive disorders of pregnancy (HDP), though research examining the implications of these new definitions on risks of developing HDP and the resultant sequelae is ongoing. The administration of diuretics has been shown to reduce postpartum hypertension among women with HDP. Widespread implementation of telemedicine models and remote assessment of ambulatory blood pressures has increased data available on postpartum blood pressure trajectories, which may impact clinical management. Additionally, policy changes such as postpartum Medicaid extension and an increasing emphasis on building bridges to primary care in the postpartum period may improve long-term outcomes for women with postpartum hypertension. Prediction models utilizing machine learning are an area of ongoing research to assist with risk assessment in the postpartum period. Summary The clinical management of postpartum hypertension remains focused on blood pressure control and primary care transition for cardiovascular disease risk reduction. In recent years, systemic innovations have improved access through implementation of new care delivery models. However, the implications of changing definitions of hypertension outside of pregnancy, increased data assessing blood pressure trajectories in the postpartum period, and the creation of new risk prediction models utilizing machine learning remain areas of ongoing research.

The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder

“…It is often extremely difficult, if not impossible, to differentiate methamphetamine-induced hypertension from gestational hypertension. Hypertension in pregnancy and postpartum should be managed according to best practices, which currently include 288 :…”

Postpartum Remote Blood Pressure Monitoring Using a Mobile App in Women with a Hypertensive Disorder of Pregnancy

“…The CDC (2022b) reported that maternal mortality has continued to increase and that over 50% of these deaths occur in the postpartum period. Mortality due to hypertension is highest within the first week postpartum, often after patients have already been discharged from the hospital (Kumar et al, 2022). BP peaks between 3 and 6 days postpartum for those who experienced a normotensive pregnancy as well as for those who experienced a hypertensive disorder (Powles & Ghandi, 2017).…”

Telehealth in the Prenatal and Postpartum Periods

“…(2020) found that home blood pressure monitoring in the prenatal period was associated with reductions in prenatal visits, prenatal hospital admissions, and diagnosis of preeclampsia, with no differences in maternal, fetal or neonatal outcomes between home monitoring and conventional care. Telehealth-related interventions for monitoring, managing, and treating hypertension in the postpartum period have also expanded through innovative advances ( Kumar et al., 2022 ). Xie et al.…”