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Postpartum readmission for hypertension: Impact of blood pressure stage at initial discharge
Katherine Pressman1, Mary Ashley Cain1, Daniela Crousillat2
1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
Insights
Postpartum hypertension (HTN) readmissions were three times more likely in patients with stage 1 or 2 HTN at discharge compared to normotensive patients. This highlights the importance of blood pressure monitoring post-delivery for preventing readmissions.
Area of Science:
- Obstetrics and Gynecology
- Cardiovascular Health
- Public Health
Background:
- Postpartum hypertension (HTN) is a significant concern, leading to readmissions and potential severe maternal morbidity.
- Identifying blood pressure (BP) thresholds predictive of postpartum readmission is crucial for timely intervention.
Purpose of the Study:
- To evaluate specific blood pressure (BP) thresholds associated with postpartum readmission for hypertension (HTN).
Main Methods:
- Retrospective cohort study analyzing 29,195 deliveries.
- Classified pre-discharge BP into normal, stage 1 HTN (systolic 130-139 mmHg, diastolic 80-89 mmHg), and stage 2 HTN (systolic ≥140 mmHg, diastolic ≥90 mmHg).
- Controlled for confounding variables including demographics, comorbidities, and delivery characteristics.
Main Results:
- 0.96% of all deliveries resulted in readmission for hypertension (51% of all readmissions).
- Patients with stage 1 or stage 2 HTN prior to discharge had a significantly higher likelihood of readmission (aOR 3.03 and 3.58, respectively).
- No difference in antihypertensive prescription rates at initial discharge was observed between readmitted and non-readmitted patients.
Conclusions:
- Stage 1 and stage 2 hypertension at initial discharge are independently associated with increased risk of postpartum hypertension readmission.
- These findings underscore the need for vigilant BP monitoring and management in the immediate postpartum period.
Objective:
We sought to evaluate blood pressure (BP) thresholds associated with postpartum readmission for hypertension (HTN).
Study Design:
Retrospective cohort study.
Main Outcome Measures:
Demographics and comorbidities, including hypertensive disorders, were identified by ICD-10 codes. Readmissions for indications other than hypertension were excluded. Average BP over the 24 h prior to initial discharge was classified as normal (systolic < 130 mmHg, diastolic < 80 mmHg), stage 1 hypertension (systolic 130-139, diastolic 80-89), and stage 2 hypertension (systolic ≥ 140, diastolic ≥ 90). Association with readmission was determined, and rates of individual and composite severe maternal morbidity.
Results:
During the study period, there were 29,195 deliveries, 557 (1.9%) readmissions, 283 for hypertension (0.96% of all deliveries, 51% of all readmissions). Readmitted patients were more likely to have chronic hypertension, diabetes, substance use, mental health disorders, advanced maternal age, and cesarean delivery. There was no difference in rate of prescription for antihypertensives at the time of initial discharge. After controlling for confounding variables (controlling for race, hypertensive disorder at time of delivery, diabetes, body mass index, age, mode of delivery, substance use, gestational age at delivery, and diagnosis of mental health disorder), patients with stage 1 (aOR 3.03 [95% confidence interval (CI) 2.15-4.27]) or stage 2 (aOR 3.58 [95% CI 2.29-5.59]) HTN prior to initial discharge were associated with readmission.
Conclusion:
When compared to normotensive patients within the 24 h prior to initial discharge, patients with stage 1 or stage 2 hypertension were three times as likely to be readmitted for postpartum hypertension.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.