Women with hypertensive disorders of pregnancy continue to be at risk of developing hypertension in the postpartum period, suggests a preprint study posted on medRxiv.^1,2

This single-center, case control study retrospectively analysed data of 595 women with gestational hypertension or preeclampsia and had a recent delivery between 2014 and 2019 to identify factors associated with persistent hypertension (stage 1; systolic ≥130 or diastolic ≥80 mmHg) one-year after delivery in these patients. Data was compared with controls consisting of women with normal BP (systolic <130 mm Hg and diastolic <80 mm Hg) at 1 year postpartum.

One year after delivery, 45% (268/595) of the women in the study group continued to have high BP. On bivariate analyses, factors associated with greater likelihood of persistent hypertension one-year after childbirth among these 268 women were advanced maternal age, high BMI at first prenatal visit, at the time of delivery, and one year postpartum, mildly high BP before discharge and raised BP at 6 weeks postpartum. However, on multivariate logistic regression analysis after adjusting for confounders, factors associated with greater risk of persistent hypertension one year after delivery were mild hypertension before discharge (aOR 1.78), hypertension at 6 weeks postpartum (aOR 2.01) and higher BMI at one-year postpartum (aOR 1.07).

Nulliparous women, on the other hand, were less likely to have high BP one year after childbirth on both bivariate and multivariate analyses.

Almost half of the study population in this study were hypertensive at one year postpartum, illustrating the high prevalence of persistent hypertension among women with hypertensive disorders of pregnancy, pre-eclampsia in particular. It has also determined risk factors predicting progression to chronic hypertension, which allow timely identification of at-risk women. The association of hypertensive disorders of pregnancy and cardiovascular risk is well-known. Hence, women with gestational hypertension and pre-eclampsia, especially those who are obese or are of higher maternal age should be regularly monitored in the postpartum period for high BP and managed and referred for specialist care, if required to prevent major adverse cardiovascular events later on in life.

References

1. Livergood MC, et al. Factors associated with persistent hypertension one year postpartum in persons with gestational hypertension or preeclampsia. medRxiv, posted October 07, 2022. doi: https://doi.org/10.1101/2022.10.06.22280786
2. Persistent hypertension common, predictable a year after preeclampsia - Medscape - Oct 25, 2022.