From the Research
The target blood pressure for managing chronic hypertension postpartum should be <140/90 mmHg. To achieve this:
- Continue antihypertensive medications used during pregnancy, adjusting as needed, with common medications including labetalol (200-800 mg twice daily), nifedipine (30-90 mg daily), or methyldopa (250-1000 mg twice daily) 1.
- Monitor blood pressure regularly, at least weekly initially, then adjust frequency based on control.
- Encourage lifestyle modifications: maintain a healthy diet, exercise regularly, limit salt intake, and avoid alcohol and smoking. If breastfeeding, prefer medications known to be safe, such as labetalol, nifedipine, or enalapril, and avoid ACE inhibitors in the first 6-8 weeks postpartum. This target helps prevent cardiovascular complications while allowing for gradual blood pressure normalization, as supported by a recent study showing that antihypertensive treatment during pregnancy is associated with better blood pressure control in the postpartum period 1.
Key considerations in managing postpartum hypertension include:
- Recognizing the risks of severe hypertension and the importance of timely treatment to avoid morbidity and mortality 2.
- Identifying targets to improve the management of severe hypertension in pregnancy and postpartum, including defining quality indicators and describing care gaps 3.
- Understanding the benefits and limitations of different antihypertensive medications and their potential impact on breastfeeding and maternal health 4, 5.
- Implementing a postpartum home blood pressure monitoring program to improve care for hypertension during the postpartum period 5.
Overall, managing chronic hypertension postpartum requires a comprehensive approach that includes medication, lifestyle modifications, and regular monitoring to achieve optimal blood pressure control and minimize the risk of cardiovascular complications.