Postpartum perception of cardiovascular risk and risk modification in patients with hypertensive disorders of pregnancy

Abstract

Hypertensive disorders of pregnancy (HDP) are associated with future cardiovascular risk. We sought to assess risk-perception for future hypertension (HTN) among individuals with HDP undergoing postpartum blood pressure monitoring and a lifestyle intervention. We utilized data from a randomized clinical trial of overweight and obese individuals with HDP and no pre-pregnancy HTN. Participants were randomized postpartum to usual care, home blood pressure monitoring (HBPM), and HBPM with a remote lifestyle intervention. We collected data at enrollment and one year postpartum to assess effects of the interventions, disease severity, and need for anti-hypertensive medications on participants’ perception of risk. Questions were adapted from Kim and Walker’s validated survey of chronic diabetes risk in those with gestational diabetes (scale 1-5; 5 indicating higher risk perception). We compared data across groups using Wilcoxon rank-sum test. Multivariable logistic regression was used to model odds of ‘high’ risk perception at follow-up (score >4). Complete data was available on 129 of the 148 participants (87%). Overall, those with HDP saw themselves as high risk for developing HTN (median 4 [IQR 3,4]) at enrollment (mean 10.5±6.1 weeks postpartum). Participants randomized to lifestyle intervention or HBPM had higher risk perception at one-year postpartum compared to control (median change 0 [0,1] and 0 [0,1] vs 0 [-1, 0], respectively, p=0.04). After controlling for arm, those with preterm deliveries or who were on anti-hypertensives were more likely to see themselves as high risk compared to those with term deliveries or who did not need medications, respectively. Risk perception for future HTN in individuals with HDP is high overall. It is affected by factors such as disease severity and anti-hypertensive use and may be higher following participation in postpartum interventions. Understanding factors that influence risk perception following HDP may lead to more informed counseling and the adoption of programs which modify risk perception and mitigate future CVD risk.View Large Image Figure ViewerDownload Hi-res image Download (PPT)