Standardized postpartum blood pressure protocol and lower rates of hypertension at 6 weeks postpartum.

BACKGROUND

Hypertensive disorders of pregnancy (HDP) increase the risk of chronic hypertension (HTN) and cardiovascular (CV) disease later in life. It is unknown how strict blood pressure (BP) monitoring postpartum (PP) may affect rates of HTN at 6 weeks PP.

OBJECTIVE

We evaluate the effect of a PP HTN standardized clinical assessment and management plan (SCAMP) on HTN at 6 weeks PP.

STUDY

DESIGN

This is a secondary analysis of a prospective cohort study of patients with PP HTN at a quaternary care center for 6 months after enacting an institution-wide SCAMP. The prospective group was compared with historical controls who delivered prior to initiation of the SCAMP. The SCAMP included (1) initiation or uptitration of medication for any BP ≥150/100 or any 2 BPs ≥140/90 within a 24-h period with a goal of BP <140/90 12 h prior to discharge and (2) enrollment in a remote BP monitoring system upon discharge. Inclusion criteria were an existing diagnosis of chronic HTN or HDP and a documented BP at a 6-week PP visit. The primary outcome was HTN, defined as systolic BP (SBP) ≥140 or diastolic BP (DBP) ≥90, at 6 weeks PP. Secondary outcomes included mean BP values as measured in the outpatient setting at 6 weeks PP and use of anti-HTNs at the time of the 6-week PP visit. For all analyses, p values were two-way, and the level of statistical significance was set at p < 0.05.

RESULTS

Of 780 PP HTN patients in the prospective cohort study, 627 (80.4%) met inclusion criteria for the secondary analysis, 305 in the SCAMP cohort and 322 historical controls. The SCAMP cohort had lower rates of chronic HTN, more patients on anti-HTNs, and higher rate of nifedipine use. The primary outcome of HTN at 6 weeks PP was significantly lower in the SCAMP group (10.5% vs. 18.3%, p = 0.005). After adjusting for confounding variables, multivariable logistic regression showed that the SCAMP group had 38% reduced odds of HTN at 6 weeks PP compared to controls (adjusted odds ratio [aOR], 0.62; 95% confidence interval [CI], 0.38-0.996; p = 0.048). Mean SBP at 6 weeks PP was significantly lower in the SCAMP group (120 ± 12 vs. 124 ± 14 mmHg, p < 0.001), as was mean DBP (76 ± 8 vs. 81 ± 8 mmHg, p < 0.001). A subanalysis only including patients with diagnosed HDP and excluding those with only chronic HTN demonstrated similar findings.

CONCLUSION

Implementation of a SCAMP was associated with reduced rates of HTN at 6 weeks PP, with lower mean SBP and DBP. More data are needed to evaluate how these findings mitigate long-term HTN risk.