53 Postpartum blood pressure trajectories and risk of persistent hypertension following a hypertensive disorder of pregnancy

Abstract

Women with hypertensive disorders of pregnancy (HDP) are at increased risk for chronic hypertension (cHTN). It is unclear whether postpartum blood pressures (BPs) differ among women who develop persistent HTN from those who do not. Among women with a HDP, we evaluated BP trajectories in the first 6 weeks postpartum, and compared women with persistent hypertension to those normotensive at 6-18 months postpartum. We used home BP data collected through a remote postpartum HTN monitoring program. Women who delivered between 2/2018-6/2019, without pre-pregnancy cHTN and with a follow up BP between 6-18 months postpartum were included. We compared BP trajectories and demographics by whether women had persistent hypertension (systolic BP ≥ 130 mmHg, diastolic BP ≥ 80 mmHg or anti-hypertensive medication use). We used repeated BP measures to fit mixed-effects linear regression models with participant identifier as random intercepts and weeks postpartum as a fixed effect expressed using restricted cubic splines. Adjusted models included pre-pregnancy body mass index (pBMI) and type of HDP. We included 368 women who contributed 5,958 BPs in the first 6 weeks postpartum. 182 (49.5%) were hypertensive at follow up, and 186 (50.5%) were normotensive at follow up a mean of 12.9 +/- 3.6 months postpartum. Women hypertensive at follow up had a higher pBMI. There was no difference by race, insurance status, maternal age or type of HDP. Despite no differences in BP at first prenatal visit, women with persistent hypertension had a slower decline in BP (p<0.01 for systolic and diastolic BP) in the first 6 weeks postpartum and had higher BPs at the postpartum visit. These differences persisted in multivariable models after adjustment for pBMI and type of HDP (p<0.01 for systolic and diastolic BP). BP trajectories in the first 6 weeks postpartum distinguish women with persistent hypertension at 6-18 months. Given insurance and long-term follow up limitations for many women, BP profiles in the first 6 weeks postpartum may identify women at higher risk for persistent hypertension.View Large Image Figure ViewerDownload Hi-res image Download (PPT)