Blood Pressure Trajectories Research Articles

470 Maternal Habitual Snoring and Blood Pressure Trajectories in Pregnancy

Abstract Introduction Habitual snoring has been associated with hypertensive disorders of pregnancy. However, exactly when blood pressure (BP) trajectories diverge between pregnant women with and without habitual snoring is unknown. Moreover, the potentially differential impact of chronic versus pregnancy-onset habitual snoring on maternal BP trajectories during pregnancy has not been examined. Methods In a cohort study of 1,305 pregnant women from a large Midwestern medical center, participants were asked about habitual snoring (≥3 nights/week) and whether their symptoms began prior to or during pregnancy. Demographic and BP data throughout pregnancy, systolic (SBP) and diastolic (DBP) were abstracted from medical charts. Linear mixed models were used to examine associations between habitual snoring-onset and pregnancy BP trajectories. Results Thirty percent of women reported snoring before pregnancy (chronic snoring) and an additional 23% reported pregnancy-onset snoring. Overall, women with pregnancy-onset snoring had higher mean SBP and DBP compared to those with chronic habitual snoring or controls (non-habitual snoring). In gestational week-specific comparisons with controls, SBP became significantly higher around 20 weeks’ gestation among women with pregnancy-onset snoring and in the third trimester among women with chronic snoring. Pairwise mean differences in DBP were significant only among women with pregnancy-onset snoring relative to controls, after 15 weeks’ gestation. Conclusion In a large cohort of pregnant women, those with pregnancy-onset or chronic habitual snoring had significantly elevated systolic BP in comparison to non-habitual snoring controls, in the second and third trimester, respectively. The findings of divergent BP trajectories suggest the two groups of women with habitual snoring in pregnancy should be considered separately when evaluating gestational ‘windows’ for increased BP monitoring and provide insight into pathophysiologic changes. Support (if any) Dr. Dunietz was supported by an F32 National Research Service Award from the National Institute of Child Health and Development (NIH/NICHD F32 HD091938); Dr. O’Brien was supported by the following during the course of this study: the Gene and Tubie Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research (MICHR) grants UL1RR024986 and UL1TR000433, MICHR seed pilot grant F021024, the National Heart, Lung, and Blood Institute (R21 HL089918 and K23 HL095739) and in part by R21 HL087819.

Factors affecting systolic blood pressure trajectory in low and high activity conditions.

Background: Typically, blood pressure dips during sleep and increases during daytime. The blood pressure trend is affected by the autonomic nervous system. The activity of this system is observable in the low and high activity conditions. The aim of this study was to assess the effect of individual characteristics on systolic blood pressure (SBP) across day-night under low and high activity conditions. Methods: The samples were 34 outpatients who were candidates for evaluation of 24 hours of blood pressure with an ambulatory. They were admitted to the heart clinic of Farshchian hospital, located in Hamadan province in the west of Iran. The hourly SBP during 24 hours was considered as a response variable. To determine the factors effecting SBP in each condition, the hidden semi-Markov model (HSMM), with 2 hidden states of low and high activity, was fitted to the data. Results: Males had lower SBP than females in both states. The effect of age was positive in the low activity state (β=0.30; p<0.001) and negative in high activity state (β= -0.21; p=0.001). The positive effect of cigarette smoking on SBP was seen in low activity state (β=5.02; p=0.029). The overweight and obese patients had higher SBP compared to others in high activity state (β=11.60; p<0.001 and β=5.87; p=0.032, respectively). Conclusion: The SBP variability can be displayed by hidden states of low and high activity. Moreover, the effects of studied variables on SBP were different in low and high activity states.

Trajectories of Blood Pressure Control a Year After Randomization and Incident Cardiovascular Outcomes in SPRINT.

While studies have assessed the association between blood pressure trajectories and cardiovascular disease (CVD) outcomes using observational data, few have assessed these associations using clinical trial data. We sought to identify systolic blood pressure (SBP) trajectories and to determine if these trajectory patterns carry inherent CVD risk, irrespective of baseline blood pressure. SBP trajectories were identified using latent class group-based modeling among a cohort of Systolic Blood Pressure Intervention Trial (SPRINT) participants by incorporating SBP measures during the first 12 months of the trial postrandomization. Cox models were used to evaluate the association between SBP trajectory with CVD and all-cause mortality. Four distinct SBP trajectories were identified: "low decline" (41%), "high decline" (6%), "low stable" (48%), and "high stable" (5%). Relative to the "low decline" group, the "low stable" group was associated with a 29% increased risk of CVD (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.06-1.57) and the "high stable" group was associated with a 76% increased risk of all-cause mortality (HR: 1.76, 95% CI: 1.15-2.68). Relative to the "low stable" group, the "high stable" group was associated with a 54% increased risk of all-cause mortality (HR: 1.54, 95% CI: 1.05-2.28). Our results demonstrate that SBP trajectory patterns are associated with important cardiovascular outcomes, irrespective of baseline blood pressure, which may help better identify individuals at risk and assist with accurate adjudication of antihypertensive therapy to reduce future events.

Clustering Longitudinal Blood Pressure Trajectories to Examine Heterogeneity in Outcomes Among Preeclampsia Cases and Controls.

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Blood Pressure Trajectories Across the Life Course.

High blood pressure (BP) is a strong modifiable risk factor for cardiovascular disease (CVD). Longitudinal BP patterns themselves may reflect the burden of risk and vascular damage due to prolonged cumulative exposure to high BP levels. Current studies have begun to characterize BP patterns as a trajectory over an individual's lifetime. These BP trajectories take into account the absolute BP levels as well as the slope of BP changes throughout the lifetime thus incorporating longitudinal BP patterns into a single metric. Methodologic issues that need to be considered when examining BP trajectories include individual-level vs. population-level group-based modeling, use of distinct but complementary BP metrics (systolic, diastolic, mean arterial, mid, and pulse pressure), and potential for measurement errors related to varied settings, devices, and number of readings utilized. There appear to be very specific developmental periods during which divergent BP trajectories may emerge, specifically adolescence, the pregnancy period, and older adulthood. Lifetime BP trajectories are impacted by both individual-level and community-level factors and have been associated with incident hypertension, multimorbidity (CVD, renal disease, cognitive impairment), and overall life expectancy. Key unanswered questions remain around the additive predictive value of BP trajectories, intergenerational contributions to BP patterns (in utero BP exposure), and potential genetic drivers of BP patterns. The next phase in understanding BP trajectories needs to focus on how best to incorporate this knowledge into clinical care to reduce the burden of hypertensive-related outcomes and improve health equity.

BLOOD PRESSURE TRAJECTORIES FROM CHILDHOOD TO YOUTH AND ARTERIAL STIFFNESS IN ADULTHOOD: A 30-YEAR LONGITUDINAL FOLLOW-UP STUDY

Objective: BP trajectories may be a stronger indicator of CVD compared with single BP assessment. This study aimed to identify the subgroups of individuals sharing similar blood pressure (BP) trajectories from childhood to youth and explore the associations of these trajectories with arterial stiffness in adulthood. Design and method: A group-based trajectory model was used to identify BP trajectories among 2082 individuals in the Hanzhong adolescent hypertension cohort by using BP values repeatedly measured at four visits from childhood (6–15 years) to youth (14–23 years). This cohort was again followed up and the brachial–ankle pulse wave velocity (baPWV) was examined 30 years after the baseline survey (36–45 years). Mixed linear regression models were used to examine the associations of BP trajectories from childhood to youth with adult baPWV. Results: Among the 2082 individuals with at least three BP measurements spanning an 8-year period, three trajectory groups of systolic BP were identified as follows: the low-level group (n = 889), medium-level group (n = 1021), and high-level group (n = 172). The age-, sex-, and BMI-adjusted baPWV in adulthood presented a gradient increase with the elevation of systolic BP trajectory levels (1198.2 ± 215.5 cm/s vs. 1265.3 ± 213.6 cm/s vs. 1349.3 ± 214.5 cm/s, all p &lt; 0.001). After adjustment for potential confounding factors, the association between baPWV and systolic BP trajectories was statistically significant (adjusted β = 45.7 cm/s; p &lt; 0.001 for the medium-level group and β = 106.7 cm/s; p &lt; 0.001 for the high-level group compared with the low-level group). Similar results were obtained for the association of baPWV with the trajectories of diastolic BP and mean arterial pressure (MAP), except for pulse pressure. Conclusions: Our investigation demonstrates different BP trajectories from childhood to youth and shows the trajectories of systolic BP, DBP, and MAP are significant predictors of arterial stiffness in adulthood.

Association between systolic blood pressure trajectories and hypertension risk at late adolescence: results from 10-year longitudinal follow-up in Chinese boys

ObjectiveTo identify various systolic blood pressure (SBP) trajectories in Chinese boys between 7 and 18 years of age, and to explore their high blood pressure (HBP) risk in their late...

Exposure to metal mixtures in relation to blood pressure among children 5-7 years old: An observational study in Bangladesh.

We investigated the associations of 17 toenail metal concentrations with blood pressure using linear regression models. Principal component analysis (PCA), weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) were conducted as secondary analyses. Associations were observed for selenium with diastolic blood pressure (per doubling of exposure β = 2.91, 95% confidence interval [CI] = 1.08, 4.75), molybdenum with systolic (β = 0.33, 95% CI = 0.05, 0.61) and diastolic blood pressure (β = 0.39, 95% CI = 0.12, 0.66), tin with systolic blood pressure (β = -0.33, 95% CI = -0.60, -0.06), and mercury with systolic (β = -0.83, 95% CI = -1.49, -0.17) and diastolic blood pressure (β = -0.89, 95% CI = -1.53, -0.26). Chromium was associated with diastolic blood pressure among boys only (β = 1.10, 95% CI = 0.28, 1.92, P for interaction = 0.02), and copper was associated with diastolic blood pressure among girls only (β = -1.97, 95% CI = -3.63, -0.32, P for interaction = 0.01). These findings were largely robust to the secondary analyses that utilized mixture modeling approaches (PCA, WQS, and BKMR). Future prospective studies are needed to investigate further the impact of early life exposure to metal mixtures on children's blood pressure trajectories and cardiovascular disease risk later in life.

A COMPARATIVE STUDY OF AMBULATORY BLOOD PRESSURE LEVELS, TRAJECTORIES AND SHORT-TERM BLOOD PRESSURE VARIABILITY IN DIABETIC AND NON-DIABETIC PATIENTS WITH CKD STAGE 2, 3A, 3B AND 4

Objective: Diabetic kidney disease is the leading cause of end-stage renal disease worldwide. Whether diabetes mellitus (DM) is an additional factor leading to elevated blood pressure (BP) levels and BP variability (BPV) in patients with chronic kidney disease (CKD) is unknown. This study aimed to compare ambulatory BP levels, BP trends and BPV in diabetic and non-diabetic patients with CKD. Design and method: This study included 48 diabetic and 48 non-diabetic adult patients (&gt;18 years) with CKD (eGFR: &lt; 90 and &gt;15 mL/min/1.73m2), matched in a 1:1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All patients underwent 24-hour ambulatory BP measurement with the Mobil-O-Graph device. To evaluate the effect of diabetes and time on the trajectories of 24-hour BP levels, we performed two-way mixed ANOVA analysis for repeated measurements using hourly means. BPV was calculated using standard deviation (SD), weighted SD (wSD), coefficient of variation (CV) and average real variability (ARV) of BP during the 24-hour, day- and night-time periods. Results: In total, patients with DM had significantly higher 24-hour systolic BP (SBP) (132.13 ± 10.71 vs 124.16 ± 11.45 mmHg, p = 0.001) and similar 24-hour diastolic BP (DBP) (75.00 ± 8.43 vs 74.62 ± 6.86 mmHg, p = 0.809) compared to patients without DM. A similar trend was evident across all CKD stages. The effect of DM on BP trajectories during the recording period was significant for SBP [F = 18.766, p &lt; 0.001, partial h2 = 0.261] and marginally significant for DBP [F = 3.782, p = 0.057, partial h2 = 0.067]. 24hour SBP SD, wSD and ARV (10.94 ± 2.75 vs 9.46 ± 2.10, p = 0.004), as well as 24hour DBP SD, wSD, CV and ARV (8.23 ± 2.10 vs 7.10 ± 1.32, p = 0.002) were significantly higher in diabetic compared to non-diabetic CKD patients. Conclusions: Ambulatory SBP levels are higher and SBP-profile is different in patients with diabetic compared to those with non-diabetic CKD. Systolic and diastolic BPV are also higher in diabetic subjects. These findings may signify a higher cardiovascular risk of diabetic CKD patients.

Hypertension in Low- and Middle-Income Countries.

In recent decades low- and middle-income countries (LMICs) have been witnessing a significant shift toward raised blood pressure; yet in LMICs, only 1 in 3 are aware of their hypertension status, and ≈8% have their blood pressure controlled. This rising burden widens the inequality gap, contributes to massive economic hardships of patients and carers, and increases costs to the health system, facing challenges such as low physician-to-patient ratios and lack of access to medicines. Established risk factors include unhealthy diet (high salt and low fruit and vegetable intake), physical inactivity, tobacco and alcohol use, and obesity. Emerging risk factors include pollution (air, water, noise, and light), urbanization, and a loss of green space. Risk factors that require further in-depth research are low birth weight and social and commercial determinants of health. Global actions include the HEARTS technical package and the push for universal health care. Promising research efforts highlight that successful interventions are feasible in LMICs. These include creation of health-promoting environments by introducing salt-reduction policies and sugar and alcohol tax; implementing cost-effective screening and simplified treatment protocols to mitigate treatment inertia; pooled procurement of low-cost single-pill combination therapy to improve adherence; increasing access to telehealth and mHealth (mobile health); and training health care staff, including community health workers, to strengthen team-based care. As the blood pressure trajectory continues creeping upward in LMICs, contextual research on effective, safe, and cost-effective interventions is urgent. New emergent risk factors require novel solutions. Lowering blood pressure in LMICs requires urgent global political and scientific priority and action.

Systolic Blood Pressure Trajectories After Discharge and Long-Term Clinical Outcomes of Ischemic Stroke.

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The Association between Blood Pressure Trajectories and Risk of Cardiovascular Diseases among Non-Hypertensive Chinese Population: A Population-Based Cohort Study.

Although previous studies have discussed the association between trajectories of blood pressure (BP) and risk of cardiovascular diseases (CVDs), the association among the non-hypertensive general population of youth and middle age has not been elucidated. We used the growth mixture model to explore the trajectories of BP among the non-hypertensive Chinese population and applied Cox regression to evaluate the association between trajectories of BP and the risk of stroke or myocardial infarction (MI). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were categorized into three classes, respectively. Statistically significant associations were observed between SBP trajectories and stroke (range of adjusted hazard ratios (aHR): 1.369–3.837) or MI (rang of aHR = 6.047–13.017). Association between DBP trajectories and stroke (aHR: 3.685) or MI (range of aHR = 1.312–2.821) were also observed, although they did not reach statistical significance. Trajectories of SBP were more important risk factors than that of DBP in stroke and MI in our study population. BP management is important among pre-hypertensive adults to prevent stroke and MI when they age. Well-designed research with a larger sample size is required to confirm our findings and develop efficient methods to prevent CVDs.

Abstract MP36: Blood Pressure Reductions in the Hyperacute Phase of Large Vessel Occlusion Ischemic Stroke Are Associated With Infarct Progression and Poor Functional Outcome

Introduction: Decreases in blood pressure (BP) during endovascular therapy (EVT) have been associated with infarct progression and worse outcome after large vessel occlusion (LVO) stroke. However, BP trajectories in the hyperacute phase prior to EVT have not been well characterized. We used high-frequency BP and hemodynamic monitoring to study the timing of BP reductions during the hyperacute period of stroke and evaluated their relation to infarct progression and functional outcome. Methods: We prospectively enrolled patients with anterior circulation LVO stroke undergoing EVT. BP and cardiac hemodynamic variables were recorded every 20 seconds from ER admission until the end of EVT using non-invasive finger plethysmography. Patients underwent initial CT perfusion imaging and a follow-up MRI at 24 hours to calculate infarct growth. The following hemodynamic parameters were defined as exposure variables: the difference between admission MAP and lowest MAP (ΔMAP), MAP drop&gt; 20% from admission, MAP&lt;70 mmHg, and SBP&lt;140 mmHg. Functional outcome was measured with the modified Rankin Scale (mRS) at 90 days. Core associations between BP reductions and outcomes were studied using linear regression and logistic regression models. Results: 45 patients underwent continuous BP monitoring (age 72±17; 58% female; NIHSS 13±6). Aggregated time series data revealed a marked BP reduction around the time of imaging from which patients recovered (mean SBP 33 mmHg, duration 18 min). A sustained decrease in BP was observed after groin puncture without return to baseline BP levels. A linear regression analysis revealed a 13ml infarct growth for every 10 mmHg reduction in ΔMAP (p=0.054). Patients were divided into two groups based on median ΔMAP = 29. Those with ΔMAP ≤29 had better functional outcome at 90 days (34.78% vs. 9.09%, p = 0.038). Conclusion: Marked and frequently iatrogenic BP reductions occur around the time of initial imaging and may present a potential target for therapeutic intervention. Decrease in blood pressure before reperfusion may increase the risk of infarct progression and poor functional outcome. Changes in cardiac hemodynamic variables throughout the acute stroke period suggest a potential role for fluid resuscitation for hemodynamic optimization.

Secular Trends in Blood Pressure in Chinese Children and Adolescents Born 1981-2000: The Impact of Changing Growth Trajectories

Background: Globally, 80% of cardiovascular disease (CVD) deaths occur in low-/middle-income countries. High blood pressure (BP) is a major risk factor for CVD and has its origins in early-life. Childhood development of BP provides important information about the development of CVD risk. This study investigated how age trajectories of BP, from child to late adolescence, have changed in recent decades in China, and the mediating roles of physical growth. Methods: We used longitudinal data on 5,118 children with physical measurements between 7-18y from the China Health and Nutrition Survey 1991-2015. We applied fractional polynomial models with random effects to estimate mean trajectories of BP, BMI and height for cohorts born in 1981-85, 1986-90, 1991-95, and 1996-2000. Models for BP trajectories were also adjusted for BMI and/or height growth to assess their impact on BP trends. Results: BP trajectories (7-18y) shifted upwards with successive cohort. Compared to the earliest cohort, mean BP was higher in the latest cohort throughout childhood to late-adolescence. The increment in systolic BP was 3.8mmHg [95% CI: 2.5-5.1] in boys and 3.9mmHg [2.6-5.3] in girls at 9y, narrowed slightly during adolescence, remained at 2.8mmHg [0.7-4.9] and 2.3mmHg [0.3-4.3] respectively at 17y. Diastolic BP had similar increments to systolic BP in childhood and adolescence, but little increment in late-adolescence in girls. BMI and height trajectories also shifted upwards. The overall increment (in z-scores) was greater for height (0.55 [0.47-0.63]) than BMI (0.28 [0.20-0.35]). When adjusting for physical growth, the increment in systolic BP trajectories reduced but remained in childhood (p<0.05). The reduction was greater with adjustment for height than for BMI and the pattern was more evident in boys. Conclusions: The upward trends in BP trajectories over time among Chinese youths was largely (not entirely) explained by the increasing trends in physical growth, especially in height. The increment in BP remained in childhood after adjusting for growth, suggesting that other early-life factors might also contribute to the BP trends in Chinese children. How changes in BP within a short time frame will affect future CVD in the long term is unclear, particularly in the developing world. Funding Statement: This work was supported by the UCL Overseas Research Scholarship and China Scholarship Council to MG, https://www.csc.edu.cn/. Declaration of Interests: None declared. Ethics Approval Statement: The University of North Carolina and the Chinese Centre for Disease Control and Prevention reviewed and approved the data collection procedures.

Gestational systolic blood pressure trajectories and risk of adverse maternal and perinatal outcomes in Chinese women

BackgroundAssociations between trajectories of systolic blood pressure (SBP) during pregnancy and pregnant outcomes remain unclear and disparate.MethodsData of 20,353 mothers without chronic hypertension and who delivered live singletons between January, 2014 and November, 2019, was extracted from Taicang register-based cohort. Based on SBP measured during 10 to 40 weeks of gestation, SBP trajectories were explored using latent class growth mixture model, and their associations with maternal and neonatal outcomes were assessed by logistic regression analyses.ResultsSix heterogeneous SBP trajectories were identified: low delayed-increasing (7.47%), low reverse-increasing (21.88%), low-stable (19.13%), medium-stable (21.64%), medium reverse-increasing (16.47%), and high stable (13.41%) trajectories. The high-stable trajectory had SBP around 125 mmHg in the 10th gestational week, and increased slightly onwards. When compared with the low-stable trajectory, the high-stable trajectory had maximally adjusted odds ratio (95% confidence interval) of 5.28 (2.76–10.10), 1.30 (1.13–1.50), 1.53 (1.12–2.08), 1.32 (1.06–1.65) and 1.64 (1.08–2.48) for gestational hypertension (GH), early-term delivery (ETD), preterm delivery (PTD), small for gestational age and low birth weight (LBW), respectively. Besides, the medium reverse-increasing trajectory showed significantly increased risk of GH and ETD, while the medium-stable trajectory had significantly elevated risk of ETD and PTD. Notably, SBP trajectories slightly but significantly improved risk discrimination of GH, ETD and LBW, over traditional risk factors.ConclusionWomen with different SBP trajectories were at varied risk of adverse maternal and fetal outcomes. Meanwhile, our study suggested that BP monitoring during pregnancy is necessary, especially for women with high SBP in early pregnancy or upward trajectory.

Trans-ethnic meta-analysis identifies new loci associated with longitudinal blood pressure traits

Genome-wide association studies (GWAS) have identified thousands of genetic loci associated with cross-sectional blood pressure (BP) traits; however, GWAS based on longitudinal BP have been underexplored. We performed ethnic-specific and trans-ethnic GWAS meta-analysis using longitudinal and cross-sectional BP data of 33,720 individuals from five cohorts in the US and one in Brazil. In addition to identifying several known loci, we identified thirteen novel loci with nine based on longitudinal and four on cross-sectional BP traits. Most of the novel loci were ethnic- or study-specific, with the majority identified in African Americans (AA). Four of these discoveries showed additional evidence of association in independent datasets, including an intergenic variant (rs4060030, p = 7.3 × 10–9) with reported regulatory function. We observed a high correlation between the meta-analysis results for baseline and longitudinal average BP (rho = 0.48). BP trajectory results were more correlated with those of average BP (rho = 0.35) than baseline BP(rho = 0.18). Heritability estimates trended higher for longitudinal traits than for cross-sectional traits, providing evidence for different genetic architectures. Furthermore, the longitudinal data identified up to 20% more BP known associations than did cross-sectional data. Our analyses of longitudinal BP data in diverse ethnic groups identified novel BP loci associated with BP trajectory, indicating a need for further longitudinal GWAS on BP and other age-related traits.

Exposure to perfluoroalkyl substances and blood pressure in pregnancy among 1436 women from the Odense Child Cohort

BackgroundPrevious studies of association between exposure to poly- and perfluoroalkyl substances (PFAS) and gestational hypertension (GH) and preeclampsia (PE) have shown conflicting results, but most dichotomized outcome and did not study continuous blood pressure (BP) changes. ObjectivesTo study the association between PFAS exposure in early pregnancy and maternal BP trajectories in pregnancy, gestational hypertension and preeclampsia. Methods1436 women were enrolled in the Odense Child Cohort in early pregnancy and had a serum sample drawn, from which perfluorohexane sulfonic acid (PFHxS), perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA) and perfluorodecanoic acid (PFDA) were measured using LC–MS/MS. Repeated BP measurements through pregnancy and information on PE were obtained from hospital files. Adjusted linear mixed models were used to investigate association between PFAS exposure and BP trajectory. Associations between PFAS and PE and GH were assessed by Cox proportional hazards model. ResultsAll women had measurable concentrations of PFAS. In all of many comparisons higher PFAS exposure (apart from PFHxS) was associated with higher systolic (SBP) and diastolic (DBP) blood pressures, although not all were significant, which is unlikely to be due to chance. After adjustment, each doubling in PFOS or PFOA exposure was associated with 0.47 mmHg (95% CI: −0.13; 1.08) and 0.36 mmHg (−0.19; 0.92) higher SBP; and 0.58 mmHg (0.13; 1.04) and 0.37 mmHg (−0.05; 0.79) higher DBP. No clear associations between PFAS exposure and PE or GH were found. DiscussionThe magnitude of the association between PFAS exposure and BP might appear small, statistically non-significant and the possible clinical importance low. However, at a population level this may slightly shift the distribution of BP towards an increased incidence of GH. If BP increases in pregnancy, it may have long-term impact on health not only of the pregnant woman but also of her offspring.

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

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)

1092 Blood pressure pattern pre-pregnancy through 42-day postpartum of women with preeclampsia, gestational, and chronic hypertension

Demonstrate the difference in blood pressure (BP) patterns of women with gestational hypertension (GHTN), preeclampsia (PE), chronic hypertension (CHTN), and superimposed preeclampsia (SIPE). A retrospective cohort study of women delivered at a midwestern academic hospital between 3/1/2017 and 8/31/2019. We included all women who were ≥15 years old, had HTN identified in the ante/postnatal period, and enrolled into home 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 types of hypertensive disorders. Data from 619 women were analyzed. Of these, 38% had GHTN, 21% CHTN, 8% SIPE, 50% PE, and 32% PE with SF. Women with CHTN had significantly higher systolic BP pre-pregnancy through 42-days postpartum. Diastolic and mean arterial pressures of women with CHTN were significantly higher pre-pregnancy thought 3rd trimester and postpartum day 14 onward; no significant differences were observed on delivery day and 1st week postpartum (All p<0.05; Figure 1A). A similar BP trajectory was observed in women who developed SIPE (Figure 1B). Overall BPs were higher pre-pregnancy and during pregnancy compared to women with only CHTN. Women with GHTN had lower BPs pre-pregnancy and during pregnancy compared to other hypertensive disorders (All p<0.05; Figure 2A). Women with PE with SF demonstrated significantly higher BPs starting from 1st trimester until delivery day (All p<0.05; Figure 2B). Postpartum BPs of women with GHTN and PE either with or without SF were not significantly different compared to other hypertensive disorders. Our findings demonstrate significant differences in BP patterns among women with different hypertensive disorders even pre-pregnancy. Recognition of these patterns is necessary for identifying women at risk, providing closer surveillance, and preventing hypertension-related morbidity later in pregnancy and postpartum.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Blood Pressure Trajectories Across Pregnancy and Associations with Gestational Age at Birth: A Functional Data Analytic Approach

Research has revealed important, group-level differences in maternal blood pressure trajectories across pregnancy. These trajectories are typically constructed using multivariate statistical methods and while studies have produced useful information, these methods ignore several sources of statistical bias and the functional, dynamic processes that give rise to a single blood pressure observation.