Nearly 45% of women with severe preeclampsia initiated antihypertensive medication within 2 years postpartum, according to a recent study.
The Danish cohort study assessed antihypertensive medication use patterns within the first 2 years postpartum among nearly 785,000 women who delivered from January 1995 to December 2018, focusing on those with hypertensive disorders of pregnancy (HDP). HDP is associated with a higher likelihood of chronic hypertension and subsequent cardiovascular disease.
The study, published in JAMA Network Open, found that initiation of antihypertensive medication was more common among women with HDP, particularly those with severe preeclampsia. Specifically, 44.1% of women with severe preeclampsia initiated antihypertensive therapy within 2 years postpartum, compared to 1.8% of women with normotensive pregnancies.
Additionally, 86.6% of women with severe preeclampsia who required antihypertensive medication began treatment within the first 3 months postpartum. Women with severe preeclampsia were 57 times more likely to begin antihypertensive treatment within the first 3 months after delivery compared to those without HDP (hazard ratio = 56.9). Although hazard ratios declined over time, they continued to reflect a higher risk of starting antihypertensive therapy for up to 23 months postpartum.
However, 24.9% of women with HDP delayed starting antihypertensive therapy for more than 3 months after delivery, with 13.4% of those with severe preeclampsia initiating treatment more than 3 months postpartum, and 6.5% starting over a year postpartum.
The study also reported that 32.2% of women with preeclampsia and 37.5% of those with gestational hypertension began antihypertensive treatment within 2 years postpartum. Women with HDP who had preterm deliveries were more likely to start antihypertensive medication after childbirth compared to those who delivered at term—for instance, 24.1% of women with severe preeclampsia who delivered early began treatment, compared to 20.9% of those who delivered at term.
As many as 55.9% of women who started antihypertensive medication within 3 months after delivery needed further prescriptions beyond that period, suggesting ongoing hypertension. During the study period, beta-blockers and diuretics were the most frequently prescribed antihypertensive medications, especially for women with HDP. Over time, there was a trend towards increased use of renin-angiotensin system blockers, particularly after 2010.
The study highlighted an association between routine, systematic postpartum blood pressure monitoring and reduced delays in initiating antihypertensive treatment.
Full disclosures can be found in the published study.
