Management of postpartum hypertension.

PURPOSE OF REVIEW: Hypertensive disorders during the postpartum period are a major contributor to maternal morbidity and mortality. The most recent statistics suggest that 16% of pregnancies are complicated by hypertension, and that number is increasing. The majority of complications occur in the postpartum period, and new publications have revolutionized the way we manage postpartum hypertension.

RECENT FINDINGS: Recent studies have shown that tight blood pressure (BP) control in the postpartum period may decrease adverse maternal outcomes. Several studies have demonstrated that nifedipine lowers BP more effectively than labetalol, resulting in fewer readmissions. The use of diuretics is a topic of controversy, with mixed evidence regarding their effectiveness. A remote patient monitoring system may improve postpartum BP follow-up in low-resource settings. Patients with hypertension during pregnancy have an increased lifetime risk of cardiovascular diseases, and establishing care for long-term follow-up is an essential part of postpartum care.

SUMMARY: Contrary to historical teaching, not all hypertensive disorders are cured by delivery. Hypertension requires close follow-up during the fourth trimester, and these patients may benefit from tighter BP control. Further research should be done to establish guideline-based treatment and monitoring throughout the lifetime.