Poster Session 3
Category: Hypertension
Poster Session 3
Audra C. Fain, MD (she/her/hers)
Resident Physician
Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California, Los Angeles (UCLA)
Los Angeles, California, United States
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Thalia Mok, MD
Assistant Professor
David Geffen School of Medicine at University of California, Los Angeles (UCLA)
Los Angeles, California, United States
Jenny Y. Mei, MD (she/her/hers)
Clinical Assistant Professor
Stanford University
Stanford University, California, United States
Hypertensive disorders of pregnancy (HDP) increase risk of chronic hypertension (CHTN) and cardiovascular disease. We evaluate the effect of a postpartum (PP) HTN standardized clinical assessment and management plan (SCAMP) on persistent HTN at 6 weeks PP.
Study Design:
Secondary analysis of a prospective cohort study of patients with PP HTN at a quaternary care center for 6 months after enacting an institution-wide SCAMP. Prospective group (P) was compared with historical controls (C) who delivered prior to initiation of the SCAMP. The SCAMP included 1) initiation or uptitration of medication for any blood pressure (BP) ≥150/100 or any 2 BPs ≥140/90 within a 24 hour period with goal of BP < 140/90 12 hours prior to discharge, 2) enrollment in a remote BP monitoring system upon discharge. Inclusion criteria were existing diagnosis of CHTN or HDP and a documented BP at a 6-week PP visit. Primary outcome was persistent HTN, defined as SBP≥140 or DBP≥90 at 6 weeks PP. Secondary outcomes included mean BP values, BP ascertainment, and use of anti-HTNs. For all analyses, p-values were two-way, and level of statistical significance was set at p< 0.05.
Results:
Of 780 PP HTN patients in the prospective cohort study, 627 (80.4%) met inclusion criteria for the secondary analysis, 305 in (P) cohort and 322 historical controls (C). (P) cohort had lower rates of CHTN, more patients on anti-HTNs, and higher rate of nifedipine use (Table 1). Logistic regression demonstrated that persistent HTN at 6 weeks PP was significantly lower in (P) cohort (adjusted odds ratio [aOR], 0.62, 95% confidence interval [CI] 0.38-0.99; p=0.048) (Table 2). (P) cohort had lower mean systolic (p < 0.001) and diastolic BP (p < 0.001). (P) cohort had earlier BP assessment (p < 0.001) and higher rate of any BP ascertainment prior to 6-weeks (aOR, 4.35; 95% CI, 2.86–6.62; p < 0.001).
Conclusion:
Implementation of a SCAMP was associated with reduced persistent HTN at 6 weeks PP, with lower mean systolic and diastolic BP and improved BP ascertainment. More data is needed to evaluate how these findings mitigate long-term HTN risk.