Antihypertensive Medication Use and Prescription Discontinuation Among Postpartum Women

Hypertension is common during and after pregnancy. Patterns of antihypertensive medication discontinuation (AMD) in the postpartum period are not well characterized. This study examined factors associated with AMD among postpartum women.

A retrospective claims analysis was conducted using the Komodo Health Healthcare Map. The study included 63,312 postpartum women aged 18-64 years who delivered between January 1, 2019, and December 31, 2022, and initiated an antihypertensive medication within 30 days after live delivery. AMD was defined as the absence of any anti-hypertensive medication from index medication (days' supply + 30-day). Multivariable Poisson regression models with a log link and robust variance estimators were used.

Discontinuation occurred in 57.8% (36,576) of women. In adjusted analyses, older age was associated with lower risk of AMD compared with women aged 18-24 years (RR 0.93, 95% CI 0.93, 0.94 for ages 25-34; RR 0.89, 95% CI 0.88, 0.90 for ages 35-44; RR 0.85, 95% CI 0.82, 0.88 for ages ≥45). Hispanic (RR 1.03, 95% CI 1.02, 1.04) and Asian (RR 1.02, 95% CI 1.01, 1.04) women had higher risk of discontinuation compared with White women. Women with eclampsia (RR 0.97, 95% CI 0.97, 0.98), baseline hypertension (RR 0.95, 95% CI 0.95, 0.96), and postpartum depression (RR 0.95, 95% CI 0.94, 0.96) had lower risk of discontinuation.

Postpartum AMD was common in this national claims-based cohort. Differences across demographic and clinical subgroups highlight patient populations that may benefit from directed postpartum blood pressure follow-up and medication management.