Postpartum medical management of hypertension and risk of readmission for hypertensive complications

Abstract

Objective: To compare the risk of readmission in those receiving no treatment, labetalol, nifedipine or both at hospital discharge following delivery complicated by presence of hypertension. Study design: Retrospective study at a single tertiary care center over a 4-year period (2017–2020). Those with peripartum hypertension (pHTN), defined as any SBP greater than 140mmHg or DBP greater than 90mmHg on two occasions 4h apart during their admission for delivery were included. The primary outcome was postpartum readmission because of hypertensive complications. Analysis was stratified by medication prescribed at discharge (no treatment prescribed, labetalol, nifedipine, or both). The risks of readmission for the management of pHTN were estimated using logistic regression and adjusted for confounding variables. Results: Nineteen thousand, four hundred and twenty-five women gave birth during the study period and 4660 (24.0%) met the described definition of pHTN. Of those, 1232 (26.4%) were discharged on antihypertensive medication (s). There were 217 (4.7%) readmissions for hypertensive complications following discharge. Compared with patients who did not receive antihypertensive medication at discharge, any nifedipine prescription was found to significantly decrease the risk of readmission: monotherapy [aOR 0.27 (0.15–0.48)], nifedipine with labetalol [aOR 0.35 (0.16–0.77)]. Labetalol monotherapy was associated with increased risk of readmission [aOR 1.66 (1.06–2.61)]. Conclusion: The risk of postpartum readmission for hypertensive complication was reduced by 65% when patients were discharged on nifedipine monotherapy and 56% with combined nifedipine and labetalol treatment when compared with no treatment. Patients discharged on labetalol monotherapy were nearly six times as likely to be readmitted for hypertensive complications when compared with patients on nifedipine monotherapy.