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Antihypertensive Medication Use in First 2 Years Postpartum
Quick Takes
- The need for postpartum antihypertensive medication varies depending on the severity of hypertensive disorders of pregnancy (HDP) and the need for antihypertensive medications antepartum.
- Many patients with HDP require antihypertensive medications within the first 2 years after delivery.
Study Questions:
What is the incidence of initiation of antihypertensive medication use in the first 2 years after delivery among women with hypertensive disorders of pregnancy (HDP)?
Methods:
This was a cohort study from a Danish registry of women with ≥1 pregnancy (≥20 weeks’ gestation) who delivered from 1995 to 2018, with analysis conducted from 2022 to 2023. The National Prescription Registry was used to determine postpartum prescriptions of antihypertensive medications. The cumulative incidence and hazard ratios of initiating antihypertensive medication use was analyzed according to HDP status and antenatal medication use.
Results:
Of 784,782 women, 36,900 (4.7%) had an HDP versus no HDP (median age at delivery in both groups was 29 years). Women without an HDP had a 1.8% 2-year cumulative incidence of starting antihypertensive medications after delivery. Women with severe preeclampsia requiring antepartum medication had a 44.1% incidence of requiring antihypertensive medications at 2-years postpartum. Women who required postpartum antihypertensive medication most commonly started within 3 months of delivery; however, 13.4% (95% confidence interval [CI], 11.9%-14.1%) of women with severe preeclampsia, 24.7.% (95% CI, 24.0%-26.0%) of women with preeclampsia, 24.9% (95% CI, 22.5%-27.5%) of women with gestational hypertension, and 76.7% (95% CI, 76.3%-77.1%) of those without an HDP first filled a prescription for antihypertensive medication >3 months after delivery. Of women needing antihypertensive medication within the first 3 months postpartum, up to 56% required further prescriptions >3 months postpartum.
Conclusions:
In this cohort study, the authors conclude that up to 44% of women with a pregnancy complicated by hypertensive disorders initiated use of antihypertensive medications within 2 years of delivery.
Perspective:
Prior studies have demonstrated the association of HDP with future risk of chronic hypertension; however, less is known about the timing of initiation of antihypertensive medications after delivery. This study shows a high percentage of patients with HDP required treatment for ongoing hypertension within the first 2 years after delivery. A portion of patients did not have a prescription filled within the first 3 months of delivery, but subsequently received antihypertensives within 2 years. This indicates that close postpartum follow-up is essential for reducing the risk of untreated hypertension. Ongoing efforts to better understand the systems of care for postpartum patients can help avoid delays in addressing postpartum hypertension.
Clinical Topics: Prevention
Keywords: Antihypertensive Agents, Cardio-Obstetrics, Postpartum Period
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