Postpartum hypertension is high blood pressure that is higher than normal after childbirth. It usually starts within 1 to 2 days after delivery, but it can happen at any time for up to 6 weeks after delivery. For some women, medical treatment is required to prevent serious complications, such as seizures or stroke.

What are the causes?

• Hypertension that existed before pregnancy (chronic hypertension).
• Hypertension that comes as a result of pregnancy (gestational hypertension).
• Hypertensive disorders during pregnancy or seizures in women who have high blood pressure during pregnancy. These conditions are called preeclampsia and eclampsia.
• A condition in which the liver, platelets, and red blood cells are damaged during pregnancy (HELLP syndrome).
• Obesity.
• Diabetes.

What are the signs or symptoms?

• Headaches. These may be mild, moderate, or severe. They may also be steady, constant, or sudden in onset (thunderclap headache).
• Vision changes, such as blurry vision, flashing lights, or seeing spots.
• Nausea and vomiting.
• Pain in the upper right side of your abdomen.
• Shortness of breath.
• Difficulty breathing while lying down.
• A decrease in the amount of urine that you pass.

How is this diagnosed?

This condition may be diagnosed based on the results of a physical exam, blood pressure measurements, and blood and urine tests.

You may also have other tests, such as a CT scan or an MRI, to check for other problems of postpartum hypertension.

How is this treated?

• Medicines to reduce blood pressure (antihypertensives). Tell your health care provider if you are breastfeeding or if you plan to breastfeed. There are many antihypertensive medicines that are safe to take while breastfeeding.
• Treating medical conditions that are causing hypertension.
• Treating the complications of hypertension, such as seizures, stroke, or kidney problems.

Your health care provider will also continue to monitor your blood pressure closely until it is within a safe range for you.

Follow these instructions at home:

Learn your goal blood pressure

• First number: below 140.
• Second number: below 90.

Your blood pressure is above normal even if only the top or bottom number is above normal.

Know what to do before you take your blood pressure

• Do not drink caffeine.
• Do not drink alcohol.
• Avoid food and drink.
• Do not smoke.
• Do not exercise.

• Use the bathroom and urinate so that you have an empty bladder.
• Sit quietly in a dining room chair. Do not sit in a soft couch or an armchair. Do not talk.

Know how to take your blood pressure

To check your blood pressure, follow the instructions in the manual that came with your blood pressure monitor. If you have a digital blood pressure monitor, the instructions may be as follows:

1. Sit up straight.
2. Place your feet on the floor. Do not cross your ankles or legs.
3. Rest your left arm at the level of your heart. You may rest it on a table, desk, or chair.
4. Pull up your shirt sleeve.
5. Wrap the blood pressure cuff around the upper part of your left arm. The cuff should be 1 inch (2.5 cm) above your elbow. It is best to wrap the cuff around bare skin.
6. Fit the cuff snugly around your arm. You should be able to place only one finger between the cuff and your arm.
7. Put the cord inside the groove of your elbow.
8. Press the power button.
9. Sit quietly while the cuff fills with air and loses air.
10. Write down the numbers on the screen. These are your blood pressure readings.
11. Wait 1–2 minutes and then repeat steps 1–10.

Record your blood pressure readings

• Get one reading in the morning (a.m.) before you take any medicines.
• Get one reading in the evening (p.m.) before supper.
• Take at least 2 readings with each blood pressure check. This makes sure the results are correct. Wait 1–2 minutes between measurements.
• Write down the results in the spaces on this form.

• a.m. _____________________(1st reading) _____________________(2nd reading)
• p.m. _____________________(1st reading) _____________________(2nd reading)

• a.m. _____________________(1st reading) _____________________(2nd reading)
• p.m. _____________________(1st reading) _____________________(2nd reading)

• a.m. _____________________(1st reading) _____________________(2nd reading)
• p.m. _____________________(1st reading) _____________________(2nd reading)

• a.m. _____________________(1st reading) _____________________(2nd reading)
• p.m. _____________________(1st reading) _____________________(2nd reading)

• a.m. _____________________(1st reading) _____________________(2nd reading)
• p.m. _____________________(1st reading) _____________________(2nd reading)

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your health care provider.
• Check your blood pressure as often as recommended by your health care provider.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Keep all follow-up visits. This is important.

Contact a health care provider if:

• You have new symptoms, such as:
  • A headache that does not get better.
  • Dizziness.
  • Visual changes.
  • Nausea and vomiting.

Get help right away if:

• You develop difficulty breathing.
• You have chest pain.
• You faint.
• You have any symptoms of a stroke. "BE FAST" is an easy way to remember the main warning signs of a stroke:
  • B - Balance. Signs are dizziness, sudden trouble walking, or loss of balance.
  • E - Eyes. Signs are trouble seeing or a sudden change in vision.
  • F - Face. Signs are sudden weakness or numbness of the face, or the face or eyelid drooping on one side.
  • A - Arms. Signs are weakness or numbness in an arm. This happens suddenly and usually on one side of the body.
  • S - Speech. Signs are sudden trouble speaking, slurred speech, or trouble understanding what people say.
  • T - Time. Time to call emergency services. Write down what time symptoms started.
• You have other signs of a stroke, such as:
  • A sudden, severe headache with no known cause.
  • Nausea or vomiting.
  • Seizure.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• Postpartum hypertension is high blood pressure that remains higher than normal after childbirth.
• For some women, medical treatment is required to prevent serious complications, such as seizures or stroke.
• Follow your health care provider's instructions on how to record your blood pressure readings.
• Keep all follow-up visits. This is important.