Could this new hypertension be postpartum related?

[JenCorn]

I stumbled on this site out of a little bit of desperation. Here's my story: I had my 2nd baby 3/21 this year. My pregnancy was great, awesome bp readings the whole way (same as first). I had trace protein for the last several office visits, I think even +1 at one point but it went back down. Great, drug free delivery, happy baby... Then I went in for my first pp checkup at 8 weeks after. Bp was 140/100. It's been a whirlwind almost 5 weeks since of fear, hope, discouragement. I've been to the ER twice. I've been on atenolol and captopril which made me feel awful, then on to bystolic and enalapril low doses. Those were doubled after a few days. Then I saw a bp specialist after a couple more days and was switched to labetalol instead of bystolic. I'm now up to 20 mg of enalapril 2x/day and 200 mg labetalol 3x/day and it just spiked back up to 187/115 tonight Both ER docs thought it was postpartum hypertension but my OB, general practitioner and bp specialist aren't so sure. I've had kidney CT scan, lots of blood work, 24 hour urine catch... I'm reaching the end of my rope here! I guess I'm just looking for some support here. Really wishing to hear similar experiences but not so sure anyone's case is as odd as mine has anyone had bp medicines not work? I'm young, thin, otherwise healthy, no family history of hypertension before menopause... Any thoughts appreciated!!

[angieb]

Pregnancy can absolutely "unmask" chronic hypertension for some women. Some times it does eventually go away (especially in cases where weight may be a factor and the patient loses weight, not likely a factor with you obviously.) Sometimes it is just a chronic thing. I hope you can find a new combo of meds that work well for you and don't make you feel bad, and hopefully your bp will go back to normal soon.

[cjd1975]

Hi had postpartum preeclampsia 5 days postpartum with my second pregnancy. We don't know if I had it with my first. I had normal BP and no proteinuria during my pregnancy it was just after I had delivered and not even for 5 days! I was on BP meds for 3 weeks and then it resolved. From what I understand, you can develop it up to 6 weeks postpartum.

[caryn]

What are your pressure readings like today?

When the placenta's hypoxic - which it is during labor, since the contractions squeeze the blood supply - it dumps a bunch of sFlt into your system. This is ordinarily *good* because it helps to kill off the blood vessels attaching the placenta to the uterus so that it will detach postpartum. But some of us are walking very close to the line where that chemical gets overproduced for our systems, and we end up with postpartum pressure increases that can take weeks to resolve.

The thing about that for you, though, is that it does seem like it's been a lot of weeks, and so it's odd to have it sticking around so long if it's just postpartum hypertension. So it's possible that what you're seeing is unmasked chronic hypertension. Another way of saying that is that the strain of hosting that particular foreign placenta can create long-term inflammation, a persistent innate immune response, and the reason you'd see it postpartum would be that the placenta is generally also good at manipulating your blood pressure. Once it's out, though, your immune system might still be annoyed, but not be getting any compensatory anti-inflammatory signalling from the placenta.

My pressures took 3-4 *months* to drop postpartum, so I'm considered a chronic hypertensive, but my most recent pressure readings have been quite low. That said, I think I get a bit of a spike before my monthly cycle starts, which would be consistent with being a chronic (we're often sensitive to progesterone.)

[JenCorn]

Thank you for the support! I went up to 1200 mg/day of labetalol before they realized it wasn't working so now I'm on Norvasc and Enalapril. It seems to be working...but then again it's only been 2 days so I'll have to wait and see if my body keeps responding. The first morning after I first took Norvasc, i took my lowered dose of labetalol and my bp went down to 97/64! So doc told me not to take anything else the whole day & I spiked to 178/108 that night. Today's been a tad high, but good numbers for me. It's been interesting to say the least. I'm baffling my doctors at this point, but right now all I really want is a solution, you know?

[JenCorn]

Caryn, you seem to be very knowledgable about all of this, I appreciate you explaining what you know. The idea of being chronic hypertensive is okay by me if it's just a title, not necessarily meaning I'll have to be on meds forever! If so, there are worse things I suppose The ER doc did tell me that he believes I might still be a pp hypertensive, but I'll just be one of the lucky ones that take up to 6 months to go back to normal. So I guess after I hit the 6 months mark, I may start to lose hope that this is a transient issue, we shall see!

[alexa5]

I had elevated bp late in my pregnancy, and then after delivering, I continued to have high bp. I had been on labetalol during pregnancy, so they kept me on that, but honestly that med didn't do anything with the pressures. They started to respond a lot better when we added hctz. I gradually weaned off meds around 6mos.... it is hard to say when my pressures normalized because I think they did earlier than that, but I was still on meds so it is hard to say. But it can take a while for all of it to normalize...some people it takes weeks, some months, and some years, and some remain hypertensive.

In my case, after it was all done, my pressures were actually a bit lower than before pregnancy, which always seems weird to me. Especially since I have all of the symptoms of a chronic hypertensive some of which Caryn mentions-- I too have higher readings around my cycle, I have white coat syndrome when getting bp read at a medical office, and just the fact that I developed high bp/severe pre-e during my pregnancy. So, I welcome my healthy readings very much, and hope they stick around for a long while!!

I hope yours calm down soon. I suspect your earlier readings were mainly due to labetalol not doing much--it is a decent drug for pregnancy, but not a top drug for hypertension in general. The other meds are probably helping a lot more. Good luck!

[trish]

Sorry you are still having BP issues. I spent a year PP with higher BP & worse BP spiking issues than I did while pregnant (even though I was on meds for the entire pregnancy). Sometimes it takes a lot of "tinkering" with different meds and dosages to get BP under control. I had several ER trips for crazy high BP (and eventually also for anxiety because of high BP) & found out I was allergic to both beta blockers and ace inhibitors.

I haven't been able to get off BP meds but I have gotten them under control. I hope you can too very soon. It's scary to have BP that high ON meds when everything you hear is that you should be getting better - not worse.

[JenCorn]

Thanks for the replies! I feel better knowing I may not be the only one with this. My new med combo is 5mg once/day and 100mg Labetalol twice/day. It has been working perfectly for about a week now. As long as I'm stable, I don't mind taking these low doses - but my end goal is of course to get off of all of them!!