Am J Perinatol 2019; 36(07): 737-741
DOI: 10.1055/s-0038-1675153
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Incidence and Risk Factors for Postpartum Severe Hypertension in Women with Underlying Chronic Hypertension

Angelica V. Glover
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Alan Tita
2   The Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
,
Joseph R. Biggio
2   The Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
3   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health System, New Orleans, Louisiana
,
Sarah B. Anderson
2   The Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
,
Lorie M. Harper*
2   The Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations
Funding This work is partially supported by grant K12HD001258, PI Andrews.
Further Information

Publication History

20 November 2017

03 September 2018

Publication Date:
29 October 2018 (online)

Abstract

Objective To determine risk factors and time to diagnosis of postpartum severe hypertension (PHTN) in women with chronic hypertension (CHTN).

Study Design Retrospective cohort of singleton pregnancies with CHTN at a tertiary care center. The primary outcome was PHTN, defined as hypertension ≥160/ ≥ 110 mm Hg during an emergency room (ER) or outpatient visit, or hospitalization within 8 weeks postpartum. Multivariable logistic regression was used to assess independent risk factors for PHTN.

Results Two-hundred thirty-five women had CHTN: 30 (12.8%) were diagnosed with PHTN, and 17 (7.2%) were hospitalized or seen in the ER for PHTN. Women with PHTN had more severe superimposed pre-eclampsia (p < 0.05), higher average systolic blood pressures at discharge (141 vs. 135 mm Hg, p = 0.04), and required antihypertensives after delivery (p < 0.01). The number of antihypertensive medications (adjusted odds ratio [aOR] 1.78, 95% confidence interval [CI], 1.25–2.55) and a systolic blood pressure >135 mm Hg (aOR 4.55, 95% CI, 1.64–12.61) at discharge remained independently associated with PHTN. Median time to diagnosis of PHTN was 10 days (interquartile range [IQR] 6–32 days); time to diagnosis among women requiring readmission or ER evaluation was 8 days (IQR 5–11 days).

Conclusion PHTN occurred in 13% of women with CHTN, and was associated with blood pressure level and number of medications at discharge.

Note

This study was presented as a poster at the 36th Annual Pregnancy Meeting, Society for Maternal-Fetal Medicine, February 1–6, 2016, Atlanta, GA.


* Lorie M. Harper is supported by K12HD001258, PI Andrews, which partially supports this work.


 
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