Clinical question: Does tighter blood pressure (BP) control postpartum reduce emergency department (ED) visits for postpartum patients, and if yes, what are the cardiovascular risk implications?
Background: More than 60% of maternal deaths occur during the postpartum period, of which hypertension is a major contributor. The current guidelines for managing postpartum hypertension are based on case series from 1987. Outside of pregnancy, new guidelines recommend more stringent blood pressure control, and it is plausible that reducing blood pressure in the postpartum period would mitigate cardiovascular disease risks in this population as well.
Study design: Prospective cohort study with propensity–score-matched retrospective cohort
Setting: Two tertiary hospitals in New Jersey
Synopsis: Between March 2023 and March 2024, an original cohort of 1,596 patients diagnosed with hypertensive disorders of pregnancy was enrolled in the study. After propensity score matching, 429 patients were treated in the retrospective, usual BP control cohort (titrating antihypertensive medications to goal of less than 150/100 mmHg), and 276 patients were enrolled in the prospective treatment cohort with tight BP control (restarting pre-pregnancy antihypertensive, continuing on labetalol, or treating with nifedipine, with a goal no more than 130/80 mmHg). Remote patient monitoring was used to monitor and titrate medication. In the intervention group, 18.8% of patients were taking antihypertensive medication, as were 18.2% in the control group. Mean highest BP was 141.8 mmHg in the intervention group and 147.8 mmHg in the control group. At 6 weeks postpartum, ED visits occurred in 10 patients (3.6%) in the prospective cohort and 36 patients (8.4%) in the retrospective cohort (risk difference, −4.8). Although limited by the propensity–score analysis design, tight blood pressure control resulted in a reduction in postpartum ED visits by 68%.
Bottom line: The American Heart Association Guidelines’ recommended blood pressure target of under 130/80 mmHg for the general population may be a goal that, when applied to the postpartum population, can improve cardiovascular outcomes.
Citation: Rosenfeld EB, et al. Management of postpartum preeclampsia and hypertensive disorders (MOPP): postpartum tight vs standard blood pressure control. JACC Adv. 2025;4(3):101617. doi:10.1016/j.jacadv.2025.101617.
Dr. Kang-Giaimo is an assistant professor of medicine, a hospitalist, and the director of the internal medicine clerkship at Yale School of Medicine in New Haven, Conn.