Incidence and Risk Factors for Postpartum Severe Hypertension in Women with Underlying Chronic Hypertension

Am J Perinatol. 2019 Jun;36(7):737-741. doi: 10.1055/s-0038-1675153. Epub 2018 Oct 29.


Objective: To determine risk factors and time to diagnosis of postpartum severe hypertension (PHTN) in women with chronic hypertension (CHTN).

Study design: Retrospective cohort of singleton pregnancies with CHTN at a tertiary care center. The primary outcome was PHTN, defined as hypertension ≥160/ ≥ 110 mm Hg during an emergency room (ER) or outpatient visit, or hospitalization within 8 weeks postpartum. Multivariable logistic regression was used to assess independent risk factors for PHTN.

Results: Two-hundred thirty-five women had CHTN: 30 (12.8%) were diagnosed with PHTN, and 17 (7.2%) were hospitalized or seen in the ER for PHTN. Women with PHTN had more severe superimposed pre-eclampsia (p < 0.05), higher average systolic blood pressures at discharge (141 vs. 135 mm Hg, p = 0.04), and required antihypertensives after delivery (p < 0.01). The number of antihypertensive medications (adjusted odds ratio [aOR] 1.78, 95% confidence interval [CI], 1.25-2.55) and a systolic blood pressure >135 mm Hg (aOR 4.55, 95% CI, 1.64-12.61) at discharge remained independently associated with PHTN. Median time to diagnosis of PHTN was 10 days (interquartile range [IQR] 6-32 days); time to diagnosis among women requiring readmission or ER evaluation was 8 days (IQR 5-11 days).

Conclusion: PHTN occurred in 13% of women with CHTN, and was associated with blood pressure level and number of medications at discharge.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Chronic Disease
  • Female
  • Humans
  • Hypertension / epidemiology*
  • Incidence
  • Logistic Models
  • Pre-Eclampsia
  • Pregnancy
  • Puerperal Disorders / epidemiology*
  • ROC Curve
  • Retrospective Studies
  • Risk Factors