Differential Diagnosis for Postpartum Hypertension

The following differential diagnosis is organized into categories to help identify the potential causes of postpartum hypertension in a woman with previously low normal blood pressure throughout her pregnancy.

• Single Most Likely Diagnosis
  • Postpartum physiological changes: The increase in blood pressure could be due to the normal physiological changes that occur postpartum, such as the resolution of the vasodilatory effects of pregnancy and the increase in vascular resistance. This is a common and usually transient phenomenon.
• Other Likely Diagnoses
  • Volume expansion and fluid shifts: Postpartum women often experience fluid shifts and volume expansion, which can lead to increased blood pressure.
  • Stress and anxiety: The postpartum period can be a stressful and anxiety-provoking time, which may contribute to elevated blood pressure readings.
  • Sleep deprivation: New mothers often experience sleep deprivation, which can lead to increased blood pressure.
• Do Not Miss Diagnoses
  • Postpartum preeclampsia: Although the patient had low normal blood pressure throughout pregnancy, it is essential to consider postpartum preeclampsia, a condition that can occur up to 6 weeks postpartum. This diagnosis is critical to rule out, as it can be life-threatening if left untreated.
  • Chronic hypertension: The patient's blood pressure may have been masked during pregnancy, and the postpartum period may unmask underlying chronic hypertension.
• Rare Diagnoses
  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause hypertension, although it is unlikely in this scenario.
  • Thyroid storm: A life-threatening condition that can cause hypertension, although it is rare and usually associated with other symptoms such as tachycardia, fever, and agitation.
  • Renal artery stenosis or other renal disorders: Rare conditions that can cause hypertension, although they are unlikely in this scenario without other symptoms or risk factors.

It is essential to note that while the patient's blood pressure is currently in the 130s/90s range, which is considered elevated but not severely hypertensive, it is crucial to monitor the blood pressure closely and evaluate for any signs or symptoms of end-organ damage or other underlying conditions. A thorough history, physical examination, and laboratory tests may be necessary to determine the underlying cause of the hypertension and guide management.