Elevated blood pressure at discharge from delivery hospitalization predicts earlier admission postpartum

1. Blood pressure ≥140/90 mmHg at discharge predicts earlier postpartum admission but does not predict severity of hypertensive disease at readmission.

2. De novo postpartum hypertensive disorders account for a substantial proportion of admissions and frequently present with severe disease.

Evidence Rating Level: 2 (Good)

Hypertensive disorders of pregnancy (HDP) are a leading cause of postpartum admission (PPA), yet it is unclear whether blood pressure (BP) at discharge from delivery hospitalization predicts the severity of subsequent postpartum hypertensive complications. In this retrospective cohort study (2016–2021), 132 individuals admitted postpartum for hypertension were evaluated. The exposure was the highest BP within 24 hours prior to delivery discharge, categorized as normal (<140/90 mmHg) or elevated (≥140/90 mmHg). The primary outcome was HDP severity at PPA, measured using a composite Severity Score incorporating sustained severe BP, laboratory abnormalities, pulmonary edema, posterior reversible encephalopathy syndrome, and eclampsia. Severity of HDP at PPA did not differ between patients discharged with normal versus elevated BP (adjusted β −0.11, 95% CI −0.33 to 0.11). However, elevated discharge BP was associated with earlier readmission (median 3 vs 5 days; adjusted β −1.59, 95% CI −3.06 to −0.12). Severe presentations were common in both groups, and 49% experienced worsening HDP diagnoses. Notably, 27% of admissions represented de novo postpartum HDP. These findings suggest that discharge BP ≥140/90 mmHg predicts earlier, but not more severe, postpartum hypertensive admissions, and highlight the substantial burden of newly presenting postpartum hypertension.

Click here to read this study in PLOS One

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