Persistent HTN Common, Predictable a Year After Preeclampsia Persistent HTN Common, Predictable a Year After Preeclampsia

The study covered in this summary was published on medRxiv.org as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Significant predictors of persistent hypertension (HTN) 1 year after pregnancy were identified in a cohort of women with gestational HTN or preeclampsia.

  • They included blood pressure (BP) in the mild-HTN range prior to discharge, elevated BP (≥130/80 mm Hg) 6 weeks postpartum, and higher body-mass index (BMI) 1-year postpartum.

Why This Matters

  • Identification of risk factors for persistent HTN a year after hypertensive disorders of pregnancy (HDP) may aid in mitigating risk for long-term HDP sequalae, which can include cardiovascular events.

Study Design

  • The retrospective, case-control study included women diagnosed with HDP during pregnancy, intrapartum, or postpartum between January 2014 and December 2019 at a single academic medical center in the Midwest.

  • The study included adult women who received prenatal care at a hospital or clinic and received a diagnosis of HDP during pregnancy, intrapartum, or during their postpartum hospitalization.

  • Cases were defined as women with HTN of stage 1 or higher 1 year after pregnancy. Controls were defined as women with normal BP, that is systolic <130 mm Hg and diastolic <80 mm Hg, 1 year after pregnancy.

  • Participants were excluded if they had chronic pregestational HTN, did not have 1-year follow-up, or were pregnant at 1-year postpartum.

Key Results

  • A total of 1445 women, representing 11.6% of deliveries at the institution during the study period, were identified with HDP or chronic HTN during pregnancy. After excluding those with chronic HTN or without a 1-year follow-up and those who had become pregnant by 1 year postpartum, 595 women were eligible for analysis.

  • Of the 595 participants, 268 (45%) had showed persistently elevated BP at 1-year postpartum.

  • Those 268 women with persistently elevated HTN were significantly older; had higher BMI at first prenatal visit, delivery, and 1-year postpartum; and were less likely to be nulliparous.

  • Participants with persistent HTN were more likely to be discharged with mildly elevated BP during their delivery hospitalization and the first 2-4 days postpartum, and have higher BP at 6 weeks postpartum.

  • In a bivariate analysis, persistent HTN 1-year postpartum was significantly associated with older age; higher BMI early in pregnancy, at delivery, and at 1-year postpartum; and mildly elevated BP prior to discharge and at 6 weeks postpartum (P < .001 for all associations).

  • In the adjusted analysis, persistent HTN 1-year postpartum was significantly associated with taking antihypertensive meds at 1-year postpartum, higher BMI, mild HTN at discharge, and HTN at 6 weeks postpartum.

Limitations

  • The study had a limited population of Hispanic persons.

  • Women who were lost to follow-up or who became pregnant by 1-year postpartum were not included.

  • The study has all the inherent limitations of its retrospective design and cannot address causality.

Disclosures

This is a summary of a preprint research study, “Factors associated with persistent hypertension one year postpartum in persons with gestational hypertension or preeclampsia,” written by M. Christine Livergood from the Medical College of Wisconsin, Milwaukee, and colleagues on medRxiv.org, provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found medRxiv.org.