Clinical characteristics and subsequent need for anti-hypertensive agents in the postpartum period for hypertensive disorders of pregnancy

Abstract

Objective: The objective of this study was to identify clinical characteristics of patients with hypertensive disorders of pregnancy associated with requiring multiple anti-hypertensive medications to optimize blood pressure in the postpartum setting. Study design: We performed a retrospective cohort study of all women who had a diagnosis of hypertensive disorders of pregnancy who delivered at a single institution between October 1, 2017 and May 1, 2021. Demographics and clinical characteristics including category of anti-hypertensive medication and number of medications were collected. Models were adjusted for race. Results: A total of 1,708 women were identified for inclusion. Of this cohort, 64.9 % did not require any anti-hypertensive medications, while 24.8 % used one medication and 10.2 % required two or more medications. When comparing women by the number of medications that were required, their demographics were similar except for race (p < 0.001). Women taking two or more medications were most prescribed a beta blocker (94.9 %) followed by a calcium channel blocker (88.6 %). Women with a history of chronic hypertension had the highest risk of requiring two or more medications for blood pressure control (adjusted RR 11.19, 95 % CI 2.63–47.60). Chronic kidney disease also significantly increased the risk of requiring two or more medications (adjusted RR 3.09, 95 % CI 1.24–7.69). Conclusion: Women with chronic hypertension and chronic kidney disease are at increased risk for requiring multiple anti-hypertensive medications in the postpartum setting. We recommend frequent postpartum visits, either in person or implementing telemedicine platforms to optimize blood pressure control for this high-risk cohort.