643 Postpartum blood pressure of black women is significantly higher compared to non-Black women

Abstract

To investigate the impact of race on blood pressure (BP) pattern of women with hypertensive disorders of pregnancy (HDP). A retrospective cohort study of women who delivered at a midwestern academic hospital between March 1st, 2017 and August 31st, 2019. We included all women who were ≥15 years old, diagnosed with HDP in the antenatal or postnatal period, and enrolled into home telehealth postpartum BP monitoring. BPs were collected from 47 time points: pre-pregnancy, each trimester, delivery day, and 42 days postpartum. The primary outcome was the estimated average BP pattern from a mixed-effects longitudinal data analysis stratified by race (White, Black, and Other). The secondary outcome was the time to BP stabilization (BP<140/90 mmHg) and hypertension resolution (stabilization while free of BP medications) stratified by race. Data from 619 women were analyzed. Of these, 38% had gestational hypertension, 21% chronic hypertension, 8% superimposed preeclampsia, 50% preeclampsia, and 32% preeclampsia with severe features. Black women compared with White and Other had significantly higher systolic BP from postpartum day 7 onward along with significantly higher diastolic BP on postpartum days 7, 14, and 30 (All p<0.05; Figure 1). Black women compared with White had significantly higher mean arterial pressure from postpartum day 7 onward (All p<0.01). However, the pulse pressure of Black women compared with White and Other was significantly higher only on postpartum day 42 (Both p<0.05). Black women were 45% less likely to achieve stabilization (HR 0.55, 95% CI: 0.38-0.77, p=0.001) than White women (Figure 2A). The time to hypertension resolution was not different between race groups (Figure 2B). We identified significant differences in BP patterns of Black women compared to White and Other race groups that may help increase awareness of critical time points. Black women need close BP monitoring during pregnancy and postpartum as well as a long-term cardiovascular follow-up as they are less likely to return to pre-pregnancy BP level.View Large Image Figure ViewerDownload Hi-res image Download (PPT)