A recent cohort study involving 2,705 patients revealed that 81.8% of individuals with hypertensive disorders of pregnancy (HDP), including preeclampsia and gestational hypertension, continued to experience hypertension after hospital discharge. Notably, 14.1% developed severe hypertension. These patients were significantly more likely to be admitted to the emergency department during the postpartum period (adjusted OR [aOR], 1.85; 95% CI, 1.17-2.92) and readmitted to the hospital (aOR, 6.75; 95% CI, 3.43-13.29) compared to those whose blood pressure normalized.
Study Overview
The study, published in JAMA Cardiology, enrolled participants in a remote blood pressure (BP) management program at a postpartum unit in a referral hospital, covering deliveries between September 2019 and June 2021. Participants had no pre-pregnancy hypertension, a mean age of 29.8 years, and a median early pregnancy body mass index (BMI) of 29.8.
Remote BP Monitoring Program
Dr. Alisse Hauspurg, the study’s principal investigator and an assistant professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at the University of Pittsburgh, emphasized the importance of remote BP monitoring programs. “These data support the critical role of remote BP monitoring programs and highlight the need for improved tools for risk stratification and consideration of liberalization of thresholds for medication initiation postpartum,” the authors wrote.
Postpartum Hypertension: A Persistent Issue
The study compared inpatient postpartum BP categories with outpatient home BP trajectories to determine optimal thresholds for inpatient antihypertensive medication initiation. There was significant overlap between post-discharge BP trajectories among those with inpatient systolic BP of at least 140 to 149 mm Hg and/or diastolic BP of at least 90 to 99 mm Hg, and those with systolic BP of at least 150 mm Hg and/or diastolic BP of at least 100 mm Hg.
Increasing Maternal Morbidity and Mortality
Maternal morbidity and mortality are on the rise in the U.S., particularly in the postpartum period. Up to 20% of pregnant patients are hypertensive, and hypertension is a major driver of maternal morbidity and mortality postpartum. Hypertension is the most common reason for postpartum hospital readmission, yet clear guidelines for optimal BP management are lacking.
Sociodemographic Diversity and Study Strengths
Key strengths of the study include the sociodemographic diversity of the sample, with 18% self-identifying as Black and 35% using public insurance at the delivery admission. All patients enrolled in the monitoring program received an automatic BP measurement device and were recommended to monitor their BP daily for the first two weeks.
Dr. Sadiya S. Khan, assistant professor of medicine (cardiology) and preventive medicine (epidemiology) at Northwestern University’s Feinberg School of Medicine, highlighted the importance of addressing social determinants of health. “Strategies that address upstream social determinants of health are urgently needed given the disproportionate burden of HDP, readmission after HDP, and lifetime risk of cardiovascular disease among minoritized individuals,” Khan wrote in an editorial in JAMA Cardiology.
Policy and Future Directions
Dr. Hauspurg emphasized the need for policy changes and further research. “There’s a lot to be done from research and policy perspectives,” she said. Future studies should evaluate whether lower thresholds for medication initiation would lead to better outcomes. Advocacy at state and federal levels is crucial to making remote BP management programs more accessible, outfitting hospitals with these programs, and covering BP cuffs for all postpartum individuals.
Rethinking Traditional Care Models
“We’ve been rethinking the traditional ways of caring for people because having them come into the office clearly isn’t working,” Hauspurg said. With less than 50% of postpartum patients attending follow-up appointments, remote BP monitoring provides a promising alternative to ensure continued care and address untreated hypertension effectively.
This article highlights the persistence of hypertension disorders in the postpartum period and underscores the necessity for comprehensive remote BP monitoring programs. The findings advocate for policy changes to improve maternal health outcomes and address the rising rates of maternal morbidity and mortality in the United States.
