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INTRODUCTION: We studied the impact of pre-existing hypertension on the management of severe hypertension in patients diagnosed with preeclampsia. METHODS: We analyzed 227 antepartum patients who developed severe blood pressures (systolic >=160 mmHg and/or diastolic >=110 mmHg) requiring IV labetalol over a 2-year period. Patients were grouped by diagnosis of chronic hypertension with superimposed preeclampsia with severe features (CHTN, n=82) versus preeclampsia with severe features (preE, n=142). Electronic records were reviewed for anthropomorphic data. Blood pressure was extracted every 15 minutes starting after the first dose of labetalol. We performed a repeated-measures analysis of variance for statistical modeling, controlling for patient-patient variance. RESULTS: The baseline systolic (SBP) and mean arterial pressure (MAP) did not differ significantly between CHTN and preE groups (SBP of 164 vs. 167 mmHg, p=0.2; MAP of 119 vs. 121 mmHg, p=0.2). ANOVA revealed a significant effect of time and demonstrated a consistently significant greater SBP decrease per unit of time in preE group compared to CHTN (p<0.002, Model R2=70%). Differences in MAP between the two groups remained constant post-treatment and approached significance (p=0.052, Model R2=67%). The greatest difference in SBP between the two groups was observed 30 and 60 min post-treatment (8 and 9 mmHg, respectively, p<0.002). CONCLUSION: Patients with pre-existing hypertension achieved a smaller reduction in SBP and MAP compared to those without, when given the same treatment for acutely severe blood pressure. This suggests that the former group of patients may benefit from alternative drug regimens to achieve adequate blood pressure control.

INTRODUCTION: We aim to assess the impact of maternal hypertension category on the control and response of urgent hypertension. METHODS: This is a retrospective cohort study of patients who required immediate-acting antihypertensive medications outlined by the ACOG Committee Opinion #692 during the peripartum admission between June 2015 to June 2017. The patients were either diagnosed with preeclampsia with severe features (“preSF”) or chronic hypertension with superimposed preeclampsia with severe features (“cHTN+preSF”). We abstracted maternal medical history and medication dosing. Statistical significance was calculated with the Student's t-test or Mann-Whitney test. Multivariable regression analysis was used to adjust for the effect of confounders. RESULTS: We identified 326 patients, 211 with preSF and 115 with cHTN+preSF. In the antepartum period, patients with cHTN+preSF received significantly more doses of immediate-acting antihypertensive medications than those with preSF (3 vs 2 doses, p<0.01). The cHTN+preSF group also required more time for blood pressures to exit severe range (55 vs 30 minutes, p<0.01) and more frequent re-dosing of anti-hypertensive medication (2 vs 1 times, p=0.02). The differences remained significant in the multivariable regression model when controlled for age, gravidity and BMI. During the postpartum period, the same parameters were similar between the groups. CONCLUSION: While chronic hypertension is recognized as a risk factor for the development of preeclampsia, we demonstrate that it also complicates and prolongs the course of blood pressure management particularly in the antepartum period. Consideration should be given to maternal history when tailoring treatment of severe hypertension in patients with pre-eclampsia.