We described a quality improvement initiative to optimize severe hypertension management.

Median time-to-target blood pressure reached institutional target following the intervention.

Appropriate antihypertensive medication use increased post-intervention.

The effect of the intervention appeared to decrease over time.

Severe hypertension (two systolic blood pressure [BP] values ≥ 160 mm Hg or diastolic BP values ≥ 110 mm Hg, 15–60 min apart) is a modifiable cause of maternal morbidity and mortality. We aimed to assess the impact of a quality improvement (QI) intervention to optimize the management of severe hypertension during pregnancy and postpartum.

We developed and implemented a QI intervention for severe hypertension management at a Canadian tertiary care center and conducted a quasi-experimental pre- and post-intervention cohort study. Pregnant and postpartum patients with a hypertensive disorder of pregnancy (HDP) between 2020 and 2022 were identified, and pre- and post-intervention cohorts were constructed.

Severe hypertension management was assessed according to quality indicators, including time-to-target BP within 60 min and use of appropriate antihypertensive therapy.

Among 697 patients with HDP, 134 (19 %) experienced severe hypertension (pre-intervention: n = 56; post-intervention: n = 78). Immediate release oral nifedipine was the most frequently used medication to treat severe hypertension episodes (63 %). Median time-to-target BP was 49.5 min pre-intervention (interquartile range [IQR] 28.0–69.8) vs. 33.5 min (IQR 19.8–65.2) post-intervention (p = 0.102). Time-to-target BP within 60 min was achieved in 64 % of patients pre- vs. 74 % post-intervention (p = 0.209), meeting our pre-established institutional target. Appropriate antihypertensive administration increased from 55 % pre-intervention to 76 % post-intervention (p = 0.014).

Developing and implementing a QI intervention resulted in achievement of our institutional target for time-to-severe hypertension resolution and increased use of appropriate antihypertensive medications. Standardized protocols and QI interventions can optimize severe hypertension management to reduce severe maternal morbidity.

Obstetrics

Pregnancy

Gestational hypertension

Preeclampsia

Hypertensive emergency

Quality improvement

© 2025 The Authors. Published by Elsevier B.V. on behalf of International Society for the Study of Hypertension in Pregnancy.