Predicting Postpartum Hypertension: A Study of High Risk Women Discharged Without Antihypertensive Therapy [37H]

Abstract

INTRODUCTION: Hypertensive disease of pregnancy is a leading cause of maternal mortality. The primary objective of our study was to identify associations between demographics and persistent postpartum hypertension, and secondary outcome to identify postpartum blood pressures predicting persistent hypertension. METHODS: We performed a retrospective electronic chart review of women with hypertensive disorders of pregnancy, delivered from 7/1/09-7/1/16. Exclusion criteria were anti-hypertensive medication upon discharge and no recorded blood pressure within 12 weeks postpartum. Study variables included maternal demographics, the three highest systolic and diastolic values <24 and 24-72 hours postpartum, and postpartum outpatient values. Chi-square and student’s T-test were used for analysis of patient demographics. A receiver operating characteristic analysis was performed to identify blood pressure values which would predict persistent hypertension. RESULTS: 591 women met study criteria. Women with persistent hypertension were significantly more likely to be multiparous (p= 0.008) and obese (p=0.016) with a trend towards increased maternal age (p=0.05). Systolic and diastolic pressures 24-72 hours after delivery were significantly associated with continued postpartum hypertension (p<0.001). No specific systolic or diastolic value within 72 hours postpartum could reliably predict persistent hypertension. CONCLUSION: Persistent postpartum hypertensive disease is more likely in multiparous, obese women, with a trend towards increasing age. Although elevated blood pressures 24 to 72 hours postpartum are significantly associated with persistent hypertension, there is no specific systolic or diastolic value above which persistence can be accurately predicted from our study. This stresses the importance of close follow up for women with hypertensive disorders of pregnancy.