Post Partum Hypertension: "It Ain't Over 'til It's Over"
Although Yogi Berra may not have been thinking about post partum hypertension when he first made this prescient observation, he pretty much 'nailed it'. Older textbooks of Obstetrics barely mention elevated blood pressure as a concern after delivery, and even opine that in the majority of cases of preeclampsia, the manifestations of the disease remit within 48 hours1. We now know that in some women hypertension persists for weeks, and even months after delivery2, and that if not addressed, post partum hypertension may lead to lethal cerebrovascular sequelae3.
In the current issue of Circulation, Goel and colleagues4 extend our knowledge of the epidemiology and mechanisms of post partum hypertension and report a high incidence (18.6%) in 988 consecutive women admitted to a tertiary medical center for cesarean section. They also report that the antepartum levels of angiogenic factors known to be relevant to the pathophysiology of preeclampsia5; soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF), as well as the ratio of sFlt1/PlGF were more likely to be abnormal in women who developed post partum hypertension compared to those who did not.
- Received September 14, 2015.
- Accepted September 16, 2015.