Timely treatment of severe maternal hypertension and reduction in severe maternal morbidity

• Published in: Pregnancy hypertension 2018-10, Vol.14, p.55-58
• Main Authors: Gupta, Megha, Greene, Naomi, Kilpatrick, Sarah J.
• Format: Article
• Language: English
• Subjects: Acute-onset severe maternal hypertension; Adult; Antihypertensive Agents - administration & dosage; Antihypertensive Agents - therapeutic use; California; Cohort Studies; Drug Administration Schedule; Female; Humans; Hypertension, Pregnancy-Induced - diagnosis; Hypertension, Pregnancy-Induced - drug therapy; Hypertension, Pregnancy-Induced - mortality; Hypertension, Pregnancy-Induced - pathology; Hypertensive disorders of pregnancy; Practice Patterns, Physicians; Pregnancy; Prenatal Diagnosis; Retrospective Studies; Risk; Severe maternal morbidity; Severity of Illness Index; Time Factors
• ISSN: 2210-7789; 2210-7797
• DOI: 10.1016/j.preghy.2018.07.010

•Antihypertensive treatment within 60 min of confirmed severe maternal hypertension is associated with a significant reduction in severe maternal morbidity. Our study supports recent ACOG and CMQCC guidelines.•Women with severe hypertension who are at a higher risk of severe maternal morbidity cannot necessarily be identified based on initial severity of blood pressures or their response to initial treatment.•Women with severe hypertension who develop severe maternal morbidity appear to have hypertension that is more difficult to treat.•Timely treatment of severe maternal hypertension with antihypertensive medications may be a marker for good overall, more vigilant care. To determine if timely treatment within 60 min of confirmed diagnosis of severe maternal hypertension with antihypertensive medications was associated with reduction in severe maternal morbidity. Medical records of women with severe hypertension (at least two severe blood pressures, systolic ≥160 mmHg and/or diastolic ≥110 mmHg, within 60 min) were accessed for timing of severe blood pressures, timing of treatment, and blood pressure response to treatment. Severe maternal morbidity was confirmed by multidisciplinary case review. We compared the incidence of severe maternal morbidity between women who received timely (within 60 min of diagnosis) vs. not-timely treatment. Of 465 women with severe hypertension, 29 (6.2%) experienced severe maternal morbidity. Fifty-six percent of women received timely treatment, of whom 1.9% had severe maternal morbidity, compared with 6.4% of women who did not receive timely treatment (p = 0.02). Timely treatment was associated with a 72% reduction in relative risk of severe maternal morbidity (p = 0.02). No significant difference was seen in median pre-treatment systolic pressures (p = 0.20) between the groups. Antihypertensive treatment within 60 min of confirmed diagnosis of severe hypertension was associated with reduction in severe maternal morbidity. Our findings support current recommendations to treat all women with severe hypertension with antihypertensive medications in a timely fashion.