Risk factors for postpartum antihypertensive medication requirement in severe preeclampsia

To determine antepartum risk factors for postpartum antihypertensive medication use in women with severe preeclampsia.

A case control study was performed on patients who were diagnosed with severe preeclampsia between January 2000 and June 2004 at a single tertiary care center. Women discharged from the hospital on antihypertensive medications were compared to women discharged home on no antihypertensive medications. Demographic data, maternal medical conditions, and delivery data were abstracted from maternal charts. Risk factors were evaluated using multiple logistic regression.

218 patients with severe preeclampsia were identified, of which 112 were discharged on antihypertensives. After adjusting for confounding variables, chronic hypertension was associated with an increased need for post partum antihypertensive medication (OR 7.5 (95% CI 3.0-18.1)). A dose-dependent association was seen with intrapartum hydralazine administration. High-dose hydralazine was associated with increased need for postpartum antihypertensive mediation (OR 5.74 95% CI 2.03-16.2) compared to low-dose hydralazine (OR of 2.51 95% CI 1.26-5.01). Hemolysis/Elevated liver function/low platelet (HELLP) syndrome was associated with a decreased need for antihypertensive medication (OR 0.33, 95% CI 0.13-0.82).

Patients with chronic hypertension and patients who required intrapartum hydralazine were more likely to require antihypertensive medications at discharge.