Outpatient treatment of Hypertensive Urgency in Pregnant and Postpartum Patients

Introduction

Hypertensive disorders of pregnancy contribute to maternal morbidity and mortality. The Alliance for Innovation in Maternal Health recommends that severe hypertension (systolic ≥160 mmHg and/or diastolic ≥110 mmHg) is treated within one hour. This study evaluated oral nifedipine for severe hypertension in an ambulatory clinic.

Methods

A retrospective chart review was performed of pregnant and postpartum patients who received nifedipine 10 mg immediate release for persistent severe hypertension in 2023. We collected demographic data, hypertensive history, treatment timelines, and outcomes. The Shapiro-Wilk test was used for normality and descriptive statistics.

Results

28 patients received in-clinic nifedipine for persistent severe hypertension. 15 (54%) were antepartum;13 (46%) postpartum. A prior hypertensive disorder was present in 12/13 antepartum and 13/15 postpartum patients respectively. Median initial blood pressure was 170 mmHg (interquartile range 166-173)/91 mmHg (interquartile range 84 -101) Nifedipine was administered within one hour in 89% (28) of cases (mean 41 minutes, standard deviation 16). 10 (66%) antepartum patients were transferred to labor and delivery for further assessment, of which, 8 (80%) did not have severe hypertension at time of initial assessment.5 (38%) postpartum patients went to the hospital for further evaluation. 61%(8) of postpartum patients were discharged home from clinic, normotensive.

Conclusions

Nifedipine can be effectively administered in under one hour in an outpatient setting. Most treated antepartum patients did not have severe hypertension on presentation to labor and delivery, while treated postpartum patients were safely discharged, reducing need for hospital evaluation. Further research is needed to evaluate impacts on obstetric outcomes.