Clinical management of hypertensive disorders in postpartum women. A narrative review

Background: Hypertensive disorders in pregnancy could persist postpartum, or appear for the first time after delivery and could require a pharmacological treatment. It was found no evidence in literature about what therapy should be used in puerperal hypertension. Objectives: To determine the effective therapy for the treatment of high postpartum systemic arterial blood pressure in women with hypertension in pregnancy or in women with de novo hypertension. Data sources: Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CCRCT), Embase, Medline, Pubmed Study eligibibility criteria, partecipants and interventions: Postnatal women with hypertension. Therapeutic treatment for management of hypertension compared with placebo or no therapy. Esclusion of preeclampsia/eclampsia. Study appraisal and synthesis methods: Results: 23 studies were included (n=23). Limitations: - Randomised controlled studies plus other experimental study designs (cohort studies, case– control studies and quasi-randomised studies) were included, and no limitations were imposed in terms of language or publication date, resulting in a comprehensive review. - This review highlights significant evidence gaps, demonstrating that further comparative research is required, particularly to clarify postpartum antihypertensive selection. Conclusions: There are insufficient evidence to recommend a particular therapy or model of care, but calcium channel blockers, beta blockers, alpha blockers and Angiotensin converting enzyme inhibitors (ACEIs) appeared variably effective. Key findings: Severe preeclampsia, Hypertension, Pregnancy, Postpartum, Very high blood pressure, Antihypertensive therapy