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Obstetrics / Obstétrique|Articles in Press

Identifying Targets to Improve the Management of Severe Hypertension in Pregnancy and Postpartum

Published:March 14, 2023DOI:https://doi.org/10.1016/j.jogc.2023.02.016
Identifying Targets to Improve the Management of Severe Hypertension in Pregnancy and Postpartum
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      Abstract

      Objectives

      To 1) define quality indicators for severe hypertension (sustained systolic blood pressure [BP] ≥160 mm Hg or diastolic BP ≥110 mm Hg) management, 2) describe care gaps, and 3) identify process issues in severe hypertension management at our tertiary care centre.

      Methods

      Pregnant and postpartum individuals diagnosed with a hypertensive disorder of pregnancy from 2018 to 2019 were identified. A retrospective cohort of patients with severe hypertension was constructed, and data were collected through chart review. Severe hypertension management was assessed according to defined quality indicators. Clinical characteristics were compared between participants with and without time-to-target BP within 60 minutes. Process issues were examined for each severe hypertension occurrence.

      Results

      Of 608 participants with a hypertensive disorder of pregnancy, 90 (15%) experienced severe hypertension. Median time-to-target BP was 76 minutes (interquartile range 47-123 minutes), and target BP (<155/105 mm Hg) was achieved within 60 minutes in 31/90 (34%) participants. Appropriate antihypertensives for severe hypertension were used in 55/90 (61%), and time-to-treatment initiation was within 30 minutes in 42/54 (78%). Chronic hypertension and oral labetalol use were associated with delays in achieving target BP. Process issues related to severe hypertension management included inappropriate treatment (n=35/90; 39%), failure to recognize severe hypertension as an emergency (n=21/90; 23%), and delayed treatment initiation (n=12/54; 22%).

      Conclusion

      We defined quality indicators for severe hypertension management. Time-to-target BP within 60 minutes was achieved in a minority of patients, and chronic hypertension was associated with delayed severe hypertension resolution. Process issues in severe hypertension management were described.

      Résumé

      Objectif

      1) Déterminer les indicateurs de qualité pour la prise en charge de l’hypertension sévère (pression artérielle systolique [PAS] soutenue de ≥ 160 mm Hg ou PA diastolique de ≥110 mm Hg); 2) décrire les lacunes dans les soins et 3) repérer les problèmes logistiques dans la prise en charge de l’hypertension sévère dans notre centre de soins tertiaires.

      Méthodologie

      La population à l’étude concerne les personnes enceintes et en post-partum ayant reçu un diagnostic de trouble hypertensif de la grossesse pour la période de 2018 à 2019. Une cohorte rétrospective de patientes atteintes d’hypertension sévère a été constituée à partir des données recueillies à l’examen des dossiers médicaux. Nous avons évalué la prise en charge de l’hypertension sévère en fonction des indicateurs de qualité définis. Nous avons comparé les caractéristiques cliniques des participantes ayant atteint ou non la PA cible dans les 60 minutes. Les problèmes logistiques ont fait l’objet d’un examen dans chacun des cas d’hypertension sévère.

      Résultats

      Des 608 participantes atteintes d’un trouble hypertensif de la grossesse, 90 (15 %) ont eu une hypertension sévère. La médiane des données en minutes pour atteindre la PA cible se chiffrait à 76 minutes (intervalle interquartile : 47-123 minutes) et 31 participantes sur 90 (34 %) ont atteint la PA cible (< 155/105 mm Hg) dans les 60 minutes. Des 90 participantes, 55 ont reçu un traitement antihypertenseur adéquat de leur hypertension sévère, et 42 d’entre elles l’ont reçu dans les 30 minutes (78 %). L’hypertension chronique et l’emploi de labétalol oral ont été associés aux temps les plus longs pour obtenir la PA cible. Les problèmes logistiques liés à la prise en charge de l’hypertension sévère comprennent le traitement inadéquat (n = 35/90; 39 %), l’incapacité à interpréter l’hypertension sévère comme une urgence (n = 21/90; 23 %) et le retardement du traitement (n = 12/54; 22 %).

      Conclusion

      Nous avons déterminé les indicateurs de qualité pour la prise en charge de l’hypertension sévère. Une minorité de patientes ont atteint la PA cible dans les 60 minutes et l’hypertension chronique a été associée à la résolution lente de l’hypertension sévère. Les problèmes logistiques liés à la prise en charge de l’hypertension sévère ont été décrits.
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      Article info

      Publication history

      Accepted: February 16, 2023
      Received in revised form: February 16, 2023
      Received: October 3, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Disclosure: The authors report no conflicts of interest.

      Funding: This work is supported by the Canadian Foundation for Women’s Health.

      Short title: Improving Severe Hypertension Management

      Identification

      DOI: https://doi.org/10.1016/j.jogc.2023.02.016

      Copyright

      © 2023 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

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