Postpartum Hypertension: Etiology, Diagnosis, and Management

Abstract

Importance: Postpartum hypertension complicates approximately 2% of pregnancies and, similar to antepartum severe hypertension, can have devastating consequences including maternal death.

Objective: This review aims to increase the knowledge and skills of women's health care providers in understanding, diagnosing, and managing hypertension in the postpartum period.

Results: Hypertension complicating pregnancy, including postpartum, is defined as systolic blood pressure 140 mm Hg or greater and/or diastolic blood pressure 90 mm Hg or greater on 2 or more occasions at least 4 hours apart. Severe hypertension is defined as systolic blood pressure 160 mm Hg or greater and/or diastolic blood pressure 110 mm Hg or greater on 2 or more occasions repeated at a short interval (minutes). Workup for secondary causes of hypertension should be pursued, especially in patients with severe or resistant hypertension, hypokalemia, abnormal creatinine, or a strong family history of renal disease. Because severe hypertension is known to cause maternal stroke, women with severe hypertension sustained over 15 minutes during pregnancy or in the postpartum period should be treated with fast-acting antihypertension medication. Labetalol, hydralazine, and nifedipine are all effective for acute management, although nifedipine may work the fastest. For persistent postpartum hypertension, a long-acting antihypertensive agent should be started. Labetalol and nifedipine are also both effective, but labetalol may achieve control at a lower dose with fewer adverse effects.

Conclusions and relevance: Providers must be aware of the risks associated with postpartum hypertension and educate women about the symptoms of postpartum preeclampsia. Severe acute hypertension should be treated in a timely fashion to avoid morbidity and mortality. Women with persistent postpartum hypertension should be administered a long-acting antihypertensive agent.

Target audience: Obstetricians and gynecologists, family physicians.

Learning objectives: After completing this activity, the learner should be better able to assist patients and providers in identifying postpartum hypertension; provide a framework for the evaluation of new-onset postpartum hypertension; and provide instructions for the management of acute severe and persistent postpartum hypertension.