Hypertensive disorders of pregnancy (HDP) account for up to 16 % of maternal deaths worldwide. Given the long-lasting consequences of HDP, optimizing blood pressure (BP) control during pregnancy and in the postpartum period is crucial to reducing maternal mortality and morbidity [1], [2].

The University of Chicago Medical Center (UCMC) established the Systematic Treatment and Management of Postpartum Hypertension Program (STAMPP-HTN) to standardize management of postpartum hypertension and improve follow-up for postpartum patients diagnosed with HDP [3]. In 2020, during the Covid pandemic, telehealth was incorporated into this program, which further reduced racial disparities [4]. Further in 2021, a remote patient monitoring (RPM) program was added as an adjunct to this program for all patients with HDP in an effort to expand accessibility and monitoring of high-risk patients [5]. RPM involves home BP telemonitoring and automatic transmission of data to healthcare providers, allowing for real-time feedback on patient status.

In patients with HDP, blood pressures tend to decrease in the first 48 h following delivery and can increase on days three to six postpartum [6]. Consistent with the evolution of postpartum BP trends, some studies have demonstrated that up to 60 % of readmissions occur prior to the first postpartum check-up [2]. Certain factors have been shown to be associated with an increased risk of readmission, including age ≥35 years, obesity, identification as Black or Asian or Pacific Islander, history of Cesarean delivery, and level of BP control in the hours preceding hospital discharge [7]. Interestingly, recent research has even suggested important implications for the choice of oral anti-hypertensive for HDP treatment [8], which underscores the need for further understanding the pathophysiology underlying postpartum BP dysregulation to better tailor medical management.

The gradual increase in blood pressure during the second half of the first postpartum week is theorized to result from fluid retention and large volumes of sodium into the intravascular compartment. Hence, the loop diuretic, furosemide, has been proposed as a solution to enhance blood pressure recovery in this window of time. Initial studies evaluating furosemide for this purpose found benefits solely in the setting of severe preeclampsia [9], [10]. However, possible benefits of furosemide in accelerating recovery even in the non-severe HDP setting, when initiated immediately postpartum, have become increasingly apparent in a randomized control trial [6].

Given the promising impact of furosemide on patient outcomes in terms of postpartum blood pressure control, in October 2021, use of oral furosemide was added to the STAMPP-RPM program. This analysis sought to evaluate the effects of furosemide in routine clinical practice especially at our institution where management of postpartum hypertension is standardized. We sought to compare hospital readmissions and blood pressure trends in the six-week postpartum period between patients who did and did not receive a five-day course of furosemide postpartum within the STAMPP-RPM program (pre-existing HDP quality improvement bundle).