乌鸦传媒

Among women who had a hypertensive disorder during pregnancy, high blood pressure in the immediate postpartum period predicted higher risk for chronic hypertension later on, researchers found.

Patients who had elevated blood pressure in the first 6 weeks postpartum (mean of 124/81 mm Hg vs 117/75 mm Hg in the normotensive group) were highly likely to develop chronic hypertension later on, according to Eesha Dave, MD, of the Magee-Women's Hospital in Pittsburgh, and colleagues.

Half of the 368 women in the analysis were still hypertensive at follow-up a mean of 12.9 months after delivery.

Additionally, patients whose blood pressure declined more slowly in the early postpartum period had a greater chance of developing persistent hypertension, Dave reported in a presentation at the Society for Maternal-Fetal Medicine annual meeting.

"In our study, blood pressure trajectories in the first 6 weeks postpartum distinguished women with persistent hypertension at 6 to 18 months," Dave said. "This may help us better identify women at risk for future chronic hypertension and cardiovascular disease in the more proximal postpartum period, which may in turn allow for early interventions during this time."

Hypertensive disorders of pregnancy, including gestational hypertension and preeclampsia, affect 10%-20% of expecting mothers, Dave stated. These conditions are risk factors for later cardiovascular illness: chronic hypertension can develop 2 to 7 years after delivery.

Dave and colleagues conducted a prospective cohort study to evaluate whether blood pressure patterns in the early postpartum period differed for mothers who developed persistent hypertension later on. The researchers compared blood pressure measurements and demographics by whether or not women had persistent hypertension, which was defined as a systolic blood pressure of more than 130 mm Hg, a diastolic blood pressure of more than 80 mm Hg, or anti-hypertensive medication use.

Researchers obtained blood pressure data collected by patients at home through a smartphone app, as part of a remote monitoring program. Women were subsequently followed for 6 to 18 months.

All study participants were recruited from a single tertiary care center, were diagnosed with a hypertensive disorder during pregnancy, and delivered a baby from February 2018 to June 2019. Participants were excluded if they had pre-pregnancy hypertension, reported fewer than two blood pressure measurements during the program, or had no available blood pressure data in long-term follow up.

Patients who were hypertensive at follow-up had a higher pre-pregnancy BMI. There were no differences in blood pressure by race, insurance status, maternal age, or type of hypertensive disorder at pregnancy.

Despite entering prenatal care with similar blood pressure measurements, women who had higher blood pressure in the 6 weeks after childbirth were more likely to develop persistent hypertension.

In a sensitivity analysis of women who were overweight or obese, a higher blood pressure in the immediate postpartum period was associated with persistent hypertension.

Dave acknowledged that this research was limited by the fact that blood pressure measurements were self-reported, analysis was limited to patients with long-term follow-up only, and the follow-up period was only 6 to 18 months postpartum.

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