Tight postpartum BP control may be beneficial in women with hypertensive disorders of pregnancy

In new mothers who had gestational hypertension or pre-eclampsia, initiating blood pressure (BP)-lowering therapy at a threshold of 140/90 mm Hg helps improve early postpartum BP control and reduce the incidence of severe hypertension, although it does not translate to a reduction in related hospital readmissions, according to a study.

The primary outcome of hospital readmissions for hypertension within 6 weeks postpartum occurred less frequently among participants in the tight BP control group than among those in the standard-of-care group for whom antihypertensive therapy was initiated at the discretion of their primary clinician (8.5 percent vs 17 percent), reported lead study author Dr Nadine Sunji from the Medical College of Wisconsin in Milwaukee, Wisconsin, US. [SMFM 2026, abstract 87]

The difference between the tight BP control group and the standard-of-care group did not reach statistical significance (p=0.080), Sunji added.

Similarly, the incidence of unplanned healthcare utilization, including ED or OB triage visits and clinic visits, within 6 weeks postpartum was numerically lower in the tight BP control vs standard-of-care group (19.2 percent vs 28.7 percent; p=0.124).

However, at 1–2 weeks postpartum, mean systolic BP levels were significantly lower in the tight BP control group, at 137.4 mm Hg as opposed to 143.1 mm Hg in the standard-of-care group (p=0.047). By 6 weeks postpartum, the two treatment groups had similar systolic BP (120.6 vs 121 mm Hg; p=0.839) and diastolic BP levels (77.1 vs 77.2 mm Hg; p=0.949).

Significantly fewer participants in the tight BP control group than in the standard-of-care group had severe hypertension (≥160/110 mm Hg) at 1–2 weeks postpartum (9.4 percent vs 20.9 percent; p=0.036). By 6 weeks postpartum, there were no significant between-group differences in the rates of stage II (≥140/90 mm Hg; 15.7 percent vs 14 percent; p=0.754) and stage III hypertension (53 percent vs 50 percent; p=0.695).

Sunji noted that the reduction in hypertension-related unplanned hospital readmissions in the tight BP control group, while not significantly different from that observed in the standard-of-care group, was “clinically meaningful.”

“The data are still promising given the absolute numbers were lower for all healthcare utilization outcomes,” she said.

The study included 94 participants each in the tight BP control and standard-of-care groups.

Those in the tight BP control group had antihypertensive therapy initiated at time of randomization with either 30 mg of extended-release nifedipine one daily or 200 mg of labetalol twice a day. Titration of medication dosing was managed by the participants’ primary clinician. In the standard-of-care group, initiation and titration of antihypertensive therapy was left to the discretion of the participants’ primary clinician.

All participants received BP cuffs and were enrolled in a remote BP monitoring program.

Baseline sociodemographic and clinical characteristics were balanced between the two treatment groups. Overall, the mean age of the participants was 31 years, 64 percent were White, and around one-third of participants had public health insurance. Roughly half of participants were nulliparous, and the median BMI at delivery was 35 kg/m².

The distribution of HDP subtypes was similar between the treatment groups, with most participants having a diagnosis of gestational hypertension followed by pre-eclampsia with severe features and pre-eclampsia without severe features. Systolic and diastolic BP levels prior to hospital discharge were comparable between groups.

Sunji acknowledged several limitations to the study.

“First, antihypertensive medication titration at home was at the discretion of the clinician combined with the remote BP monitoring algorithm. This could have led to overall higher healthcare utilization and readmission in both study groups,” Sunji noted.

“In addition, the standard-of-care group exhibited substantial variability in clinical practice, with some clinicians initiating treatment earlier and others delaying treatment until BP levels approached severe thresholds,” she said.