Severe Hypertension Treatment Trends and Racial Disparities Surrounding MFTI Implementation

Introduction: Severe hypertension in pregnancy requires antihypertensive therapy within 60 minutes to prevent maternal stroke and end-organ injury. National treatment rates range from 40-50% at baseline, with Black patients facing 3-5 times higher mortality from hypertensive disorders. The Maternal Fetal Triage Index (MFTI) is a standardized five-level acuity tool designed to improve triage prioritization. We evaluated treatment trends surrounding MFTI implementation at a Level III perinatal center and assessed for racial disparities in treatment timeliness. Methods: Retrospective cohort study of deliveries with persistent severe hypertension at Richland Hospital (Prisma Health, Columbia, SC) from January 2023 through March 2026. MFTI was implemented November 2025. Primary outcome was proportion receiving antihypertensive treatment within 60 minutes. Secondary outcomes included median time to treatment and race-stratified analysis. Chi-square testing compared pre-intervention and post-intervention proportions. Data were extracted from Epic quality metrics and Slicer Dicer queries. Results: Among 8,449 deliveries over the study period, 1,842 episodes of persistent severe hypertension were identified. The population was 41% Black and 28% White. Treatment within 60 minutes improved significantly from 60% in 2023 to 85% in 2026 (p<0.001). Median time to treatment decreased from 49 to 31 minutes. In the immediate pre-MFTI versus post-MFTI period, rates were similar (79.4% vs 80.3%, p=0.90), suggesting improvement preceded the intervention. Black patients consistently had longer median treatment times than White patients across all years (57 vs 41 minutes in 2023; 39 vs 25 minutes in 2026). Conclusion/Implications: Significant improvement in severe hypertension treatment occurred over a multi year quality improvement period, though MFTI implementation alone was not associated with an acute change in treatment rates. Persistent racial disparities in time to treatment despite overall improvement highlight the need for targeted equity-focused interventions beyond standardized triage protocols.