What is the recommended plan for monitoring and managing postpartum hypertension?

From the Guidelines

The recommended plan for monitoring and managing postpartum hypertension involves close blood pressure surveillance, with monitoring at least 4 to 6 hourly during the day for at least 3 days postpartum, and appropriate antihypertensive therapy, with first-line agents including nifedipine, amlodipine, enalapril, and labetalol 1.

Key Considerations

• Women with hypertensive disorders should be closely monitored for signs of complications, such as stroke, seizures, and pulmonary edema, with blood pressure often peaking 3-6 days after delivery 1.
• For acute severe hypertension (≥160/110 mmHg), immediate treatment with intravenous labetalol, intravenous hydralazine, or oral nifedipine is recommended to reduce the risk of stroke 1.
• Treatment should aim for blood pressure targets below 150/100 mmHg, with consideration for lower targets (140/90 mmHg) for women with comorbidities 1.
• Antihypertensive medications should be adjusted based on breastfeeding status, with labetalol, nifedipine, and methyldopa generally considered safe 1.

Monitoring and Follow-up

• Blood pressure should be monitored at least 4 to 6 hourly during the day for at least 3 days postpartum, with additional follow-up at 2-6 weeks if blood pressure remains elevated 1.
• Women with preeclampsia should be assessed in hospital when first diagnosed, and thereafter, some may be managed as outpatients once it is established that their condition is stable and they can be relied on to report problems and monitor their BP 1.

Medications

• First-line agents for the treatment of postpartum hypertension include nifedipine, amlodipine, enalapril, and labetalol, with advantages including once-daily dosing and alignment with hypertension guidelines 1.
• Alternative agents include diuretics, which could help early postpartum BP recovery after HDP, but may affect breastmilk production at higher doses 1.

From the Research

Postpartum Hypertension Monitoring and Management Plan

• Postpartum hypertension 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 2
• 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) 2
• Women with severe hypertension sustained over 15 minutes during pregnancy or in the postpartum period should be treated with fast-acting antihypertension medication, such as labetalol, hydralazine, or nifedipine 2, 3, 4

Treatment Options

• Oral antihypertensive agents, such as nifedipine, labetalol, and methyldopa, are suitable options for treatment of severe hypertension in pregnancy and postpartum 3
• For persistent postpartum hypertension, a long-acting antihypertensive agent should be started, with labetalol and nifedipine being effective options 2
• The choice of antihypertensive agent should be based on the provider's familiarity with the drug and the patient's individual needs 5

Monitoring and Follow-up

• Women with postpartum hypertension should be closely monitored for signs of severe hypertension and end-organ damage 4, 6
• Follow-up care should include regular blood pressure checks and assessment for any symptoms of postpartum preeclampsia or eclampsia 2, 6
• The management of postpartum hypertension should be individualized and based on the patient's specific needs and medical history 6