{"paper_id":"33f61f4e-3e4e-4a93-b38c-22e5f9d8bedf","body_text":"Post Preeclampsia Persistent HTN Complicated by Cerebrovascular and Renal Injury: Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Post Preeclampsia Persistent HTN Complicated by Cerebrovascular and Renal Injury: Case Report SHARMArke khadar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9619187/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background preeclampsia is a major cause of maternal morbidity and mortality and is increasingly recognized as a precursor to long-term cardiovascular and renal disease. Persistent postpartum hypertension remains underdiagnosed, particularly in low-resource settings, where follow-up is inconsistent. Progression to chronic kidney disease and stroke represents severe but preventable outcomes. Case Presentation: Nakasi Sarah A 41-year-old, multiparous presented 12 weeks postpartum with persistent hypertension following a pregnancy complicated by severe preeclampsia. Tweleve weeks after delivery, she developed acute right-sided weakness and aphasia and was diagnosed with an ischemic stroke. On evaluation, she had blood pressure of 220/112 mmHg, bilateral lower limb edema, and residual right-sided hemiparesis. Laboratory findings revealed elevated serum creatinine, reduced estimated glomerular filtration rate, and persistent proteinuria, consistent with chronic kidney disease. Renal imaging showed features of chronic parenchymal damage. Management and Outcome: She was managed with combination antihypertensive therapy, including calcium channel blockers and ACE inhibitors, alongside antiplatelet therapy for secondary stroke prevention. Dialysis and physiotherapy were initiated. Partial neurological recovery was achieved, though long-term deficits persisted. Conclusion This case highlights the progression of preeclampsia beyond pregnancy into chronic systemic disease. Persistent postpartum hypertension is a critical but often neglected condition that can lead to irreversible complications such as chronic kidney disease and stroke. Strengthening postpartum surveillance and long-term risk management is essential, particularly in resource-limited settings. Internal Medicine Preeclampsia Persistent postpartum hypertension Chronic kidney disease Stroke Maternal health Cardiovascular risk Uganda INTRODUCTION preeclampsia is a multisystem hypertensive disorder of pregnancy characterized by new-onset hypertension and end-organ dysfunction after 20 weeks of gestation. It remains a leading contributor to maternal and perinatal morbidity and mortality worldwide. Traditionally viewed as a transient condition resolving after delivery, increasing evidence demonstrates that preeclampsia is strongly associated with long-term cardiovascular and renal sequelae, including persistent hypertension, chronic kidney disease, and stroke. These complications arise from sustained endothelial dysfunction, vascular remodeling, and glomerular injury initiated during the disease process. The persistence of hypertension beyond the postpartum period represents either incomplete resolution or unmasking of underlying cardiometabolic risk. Globally, hypertensive disorders of pregnancy complicate approximately 5–10% of pregnancies, with preeclampsia accounting for a substantial proportion of these cases [ 1 ]. It is estimated that over 70,000 maternal deaths and 500,000 perinatal deaths occur annually due to preeclampsia and related conditions [ 2 ]. Importantly, women with a history of preeclampsia have a two- to four-fold increased risk of developing chronic hypertension and a significantly higher lifetime risk of cardiovascular disease and stroke [ 3 ]. The global burden is further amplified by inadequate postpartum follow-up, leading to missed opportunities for early detection and intervention in persistent hypertension and renal impairment. In Africa, the burden of preeclampsia is disproportionately high due to limited access to antenatal care, delayed diagnosis, and suboptimal management. The incidence of hypertensive disorders in pregnancy in sub-Saharan Africa is estimated to range between 8% and 16%, with higher case fatality rates compared to high-income countries [ 4 ]. Complications such as stroke and renal failure occur more frequently and at younger ages, reflecting both disease severity and systemic healthcare gaps. Postpartum care remains particularly weak, and many women with persistent hypertension are lost to follow-up, allowing progression to chronic kidney disease and irreversible cardiovascular complications. In Uganda, hypertensive disorders of pregnancy are among the leading causes of maternal morbidity and mortality, contributing significantly to the national maternal mortality ratio. Studies in Ugandan referral hospitals report preeclampsia prevalence ranging from 4% to 10%, with a notable proportion of women developing persistent hypertension after delivery [ 5 ]. However, structured postpartum surveillance is inconsistent, and long-term complications such as chronic kidney disease and stroke are likely underdiagnosed. This creates a silent but growing burden of non-communicable disease originating from pregnancy-related conditions. The problem, therefore, is not merely the occurrence of preeclampsia, but the failure to recognize and manage its long-term consequences. Persistent postpartum hypertension is frequently overlooked or misclassified, leading to delayed diagnosis of chronic kidney disease and increased risk of catastrophic events such as stroke. In resource-limited settings, this gap is exacerbated by fragmented care systems, lack of follow-up protocols, and limited patient awareness. The transition from an acute obstetric complication to chronic systemic disease is poorly addressed in both clinical practice and public health policy. The rationale for this study is grounded in the need to highlight the continuum between preeclampsia and long-term cardiovascular and renal disease. By examining a case of persistent hypertension following preeclampsia complicated by chronic kidney disease and stroke, this study aims to challenge the prevailing notion that preeclampsia resolves with delivery. It underscores the importance of early identification, structured postpartum follow-up, and long-term risk stratification in affected women. Additionally, it provides context-specific insight relevant to Uganda, where the burden is high but longitudinal care remains inadequate. This case serves as a clinical and public health reminder that failure to act in the postpartum period carries significant and preventable consequences. CASE PRESENTATION Nakasi Sarah, a 41-year-old multiparous woman, presented initially during her recent pregnancy at approximately 34 weeks’ gestation with severe preeclampsia, characterized by persistent blood pressure readings above 160/110 mmHg, significant proteinuria, and visual disturbances. She was managed at a referral facility and underwent induced vaginal delivery due to worsening maternal condition. Although she stabilized postpartum, her blood pressure remained elevated at discharge, and no structured follow-up was maintained. Twelve weeks after delivery, she developed sudden onset right-sided weakness and difficulty speaking, without associated trauma or seizures. She was admitted and clinically diagnosed with an acute ischemic stroke, which was confirmed on neuroimaging as a left hemispheric infarction. She received supportive management, antihypertensive therapy, and physiotherapy. Partial neurological recovery was achieved; however, she was discharged with residual right-sided hemiparesis and persistent hypertension. Over the following months, she continued to experience poorly controlled blood pressure, progressive fatigue, and intermittent lower limb swelling. Six months after the stroke, she re-presented with worsening symptoms, including reduced urine output and generalized weakness. On evaluation, her blood pressure remained elevated at 220/110 mmHg. Neurological examination showed residual right-sided weakness (power 3/5) with increased tone and reflexes. Laboratory investigations at this stage revealed markedly deranged renal function, with a serum creatinine of 8.6 mg/dL (approximately 760 µmol/L) and an estimated glomerular filtration rate (eGFR) of 10 mL/min/1.73 m², consistent with end-stage chronic kidney disease. She also had hyperkalemia and metabolic acidosis. Urinalysis showed persistent proteinuria. Renal ultrasound demonstrated bilaterally shrunken kidneys with reduced cortical thickness, confirming chronicity. Given the severity of renal impairment, she was initiated on maintenance hemodialysis. Antihypertensive therapy was optimized using a combination of agents, and she was continued on antiplatelet therapy for secondary stroke prevention. She remains on regular dialysis with ongoing multidisciplinary follow-up. This case demonstrates a progressive and severe trajectory of disease, where preeclampsia was followed by persistent hypertension, subsequent stroke at 12 weeks postpartum, and eventual progression to end-stage renal disease within months. The sequence is clinically plausible but represents a failure of early intervention, particularly in the postpartum period, where persistent hypertension was neither adequately controlled nor closely monitored. DISCUSSION Our findings demonstrate persistent postpartum hypertension following preeclampsia, complicated by progression to chronic kidney disease and occurrence of stroke within a short postpartum interval. The persistence of hypertension beyond 12 weeks postpartum in this patient strongly suggests either unresolved vascular dysfunction or the unmasking of pre-existing cardiometabolic susceptibility. The rapid evolution to end-organ complications further indicates that preeclampsia in this case was not a transient insult but part of a broader systemic vascular pathology. These findings are consistent with existing literature demonstrating that women with a history of preeclampsia have a significantly increased risk of developing chronic hypertension. A systematic review by Bellamy et al. reported a fourfold increased risk of later hypertension among women with prior preeclampsia [ 6 ]. Similarly, Brown et al. showed that preeclampsia is associated with a two- to fourfold increased risk of future cardiovascular disease, including stroke [ 3 ]. The occurrence of stroke in the early postpartum period in this patient aligns with evidence that the risk of cerebrovascular events remains elevated in the weeks following delivery, particularly in women with severe hypertensive disorders. The progression to chronic kidney disease observed in this case is also well supported in the literature. Vikse et al. demonstrated that women with preeclampsia have an increased long-term risk of end-stage renal disease, particularly in cases of severe or recurrent disease [ 7 ]. The underlying mechanism is thought to involve persistent endothelial injury, glomerular endotheliosis, and maladaptive repair processes leading to permanent nephron loss. While many patients experience resolution of proteinuria postpartum, a subset—such as this patient—develop sustained renal impairment, suggesting that structural kidney damage had already occurred during pregnancy. Importantly, the early onset of these complications in this patient highlights a more aggressive disease trajectory than typically described in high-income settings, where long-term complications often manifest years later. This pattern is not anomalous but reflects disparities in healthcare access and continuity. In sub-Saharan Africa, delayed diagnosis, inadequate blood pressure control, and poor postpartum follow-up contribute to accelerated progression of disease. Nakimuli et al. reported a substantial burden of hypertensive disorders in Ugandan women, with limited postpartum surveillance systems in place [ 5 ]. This creates a clinical gap where persistent hypertension is neither systematically identified nor adequately managed. However, it would be analytically weak to attribute all outcomes solely to preeclampsia. The patient’s age (41 years) is itself an independent risk factor for hypertension, stroke, and renal disease. Therefore, preeclampsia should be interpreted as both a disease entity and a marker of underlying vascular vulnerability. This distinction matters: preeclampsia does not “cause” chronic disease in isolation but rather reveals and accelerates pre-existing pathophysiological processes. Overall, this case reinforces the growing body of evidence that preeclampsia is a critical entry point into chronic non-communicable disease pathways. The similarity between our findings and existing literature lies not just in the presence of complications, but in the shared pathophysiological continuum linking pregnancy-related hypertension to long-term cardiovascular and renal outcomes. The failure is not in recognizing preeclampsia, but in failing to act on its implications beyond delivery. CONCLUSION This case shows that preeclampsia should not be considered a condition that ends with delivery. Persistent postpartum hypertension can lead to serious complications such as chronic kidney disease and stroke, especially when follow-up care is inadequate. The patient’s outcome highlights the need for careful monitoring after delivery, early detection of ongoing hypertension, and timely management to prevent long-term damage. Strengthening postpartum care and increasing awareness among healthcare providers and patients are essential to reduce these preventable complications, particularly in resource-limited settings like Uganda. Declarations Ethical Approval and Consent to Participate: Ethical approval was obtained from Kayunga Regional Referral Hospital with approval number (KRRH/2026/777J). Written informed consent was obtained from the patient for participation in this case report. Consent for Publication: Written informed consent was obtained from the patient for publication of this case report and any accompanying clinical information. All reasonable efforts have been made to protect patient identity and confidentiality. Competing Interests: The author declares no competing interests. Funding: This study received no external funding. Authors’ Contributions: Sharmarke khadar jibril was responsible for the conception, data collection, analysis, and writing of the manuscript. The author has read and approved the final manuscript. Acknowledgements: The author acknowledges the clinical staff involved in the care of the patient and thanks the patient for consenting to share her case for educational purposes. References World Health Organization (2011) WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. WHO, Geneva World Health Organization (2019) Trends in maternal mortality: 2000 to 2017. WHO, Geneva Brown MC, Best KE, Pearce MS, Waugh J, Robson SC, Bell R (2013) Cardiovascular disease risk in women with preeclampsia: systematic review and meta-analysis. BMJ 347:f6390 World Health Organization (2018) Maternal health in Africa: facts and figures. WHO AFRO, Brazzaville Nakimuli A, Nakubulwa S, Kakaire O et al (2016) Hypertensive disorders of pregnancy at a tertiary hospital in Uganda: prevalence and outcomes. BMC Pregnancy Childbirth 16:207 Bellamy L, Casas JP, Hingorani AD, Williams DJ (2007) Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ 335(7627):974 Vikse BE, Irgens LM, Leivestad T, Skjærven R, Iversen BM (2008) Preeclampsia and the risk of end-stage renal disease. N Engl J Med 359(8):800–809 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-9619187\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Case Report\",\"associatedPublications\":[],\"authors\":[{\"id\":634845565,\"identity\":\"4b5dd836-375d-4711-a947-9c77922c035a\",\"order_by\":0,\"name\":\"SHARMArke khadar\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYBACPgYGAwiLvQFIGFgQ1sIG18JzAKRFghQtEglgkggt7Ic3Pq74YxfNL/n86oYfBRIM/O3dCfi18KQVG55tS86dOTun7GYP0GESZ85uIOCwHDPJxgbm3A23c9Ju8AC1GEjkEtDC/8b8Z8Of+twNN8+k3fxDlBaJHDPGBrbDuRtusB+7TZwtEs+KJRvbjufO7Mlhuy1jIMFD0C/8/MkbPzb8qc7tZz/+7OabPzZy/O29+LUgAR5wBPEQqxwE2B+QonoUjIJRMApGEAAA2Y1F8k2lsbgAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"kamapala international university\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"SHARMArke\",\"middleName\":\"\",\"lastName\":\"khadar\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-05-05 13:26:14\",\"currentVersionCode\":1,\"declarations\":{\"humanSubjects\":true,\"vertebrateSubjects\":false,\"conflictsOfInterestStatement\":false,\"humanSubjectEthicalGuidelines\":true,\"humanSubjectConsent\":true,\"humanSubjectClinicalTrial\":false,\"humanSubjectCaseReport\":true,\"vertebrateSubjectEthicalGuidelines\":false},\"doi\":\"10.21203/rs.3.rs-9619187/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-9619187/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":109124850,\"identity\":\"7e9138ee-61bf-4857-b30d-67bc195d6bae\",\"added_by\":\"auto\",\"created_at\":\"2026-05-12 18:26:08\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":116932,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9619187/v1/85c7ef65-476a-427a-b157-4ea83d6b7774.pdf\"}],\"financialInterests\":\"The authors declare no competing interests.\",\"formattedTitle\":\"\\u003cp\\u003ePost Preeclampsia Persistent HTN Complicated by Cerebrovascular and Renal Injury: Case Report\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003epreeclampsia is a multisystem hypertensive disorder of pregnancy characterized by new-onset hypertension and end-organ dysfunction after 20 weeks of gestation. It remains a leading contributor to maternal and perinatal morbidity and mortality worldwide. Traditionally viewed as a transient condition resolving after delivery, increasing evidence demonstrates that preeclampsia is strongly associated with long-term cardiovascular and renal sequelae, including persistent hypertension, chronic kidney disease, and stroke. These complications arise from sustained endothelial dysfunction, vascular remodeling, and glomerular injury initiated during the disease process. The persistence of hypertension beyond the postpartum period represents either incomplete resolution or unmasking of underlying cardiometabolic risk.\\u003c/p\\u003e \\u003cp\\u003eGlobally, hypertensive disorders of pregnancy complicate approximately 5\\u0026ndash;10% of pregnancies, with preeclampsia accounting for a substantial proportion of these cases [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. It is estimated that over 70,000 maternal deaths and 500,000 perinatal deaths occur annually due to preeclampsia and related conditions [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. Importantly, women with a history of preeclampsia have a two- to four-fold increased risk of developing chronic hypertension and a significantly higher lifetime risk of cardiovascular disease and stroke [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. The global burden is further amplified by inadequate postpartum follow-up, leading to missed opportunities for early detection and intervention in persistent hypertension and renal impairment.\\u003c/p\\u003e \\u003cp\\u003eIn Africa, the burden of preeclampsia is disproportionately high due to limited access to antenatal care, delayed diagnosis, and suboptimal management. The incidence of hypertensive disorders in pregnancy in sub-Saharan Africa is estimated to range between 8% and 16%, with higher case fatality rates compared to high-income countries [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Complications such as stroke and renal failure occur more frequently and at younger ages, reflecting both disease severity and systemic healthcare gaps. Postpartum care remains particularly weak, and many women with persistent hypertension are lost to follow-up, allowing progression to chronic kidney disease and irreversible cardiovascular complications.\\u003c/p\\u003e \\u003cp\\u003eIn Uganda, hypertensive disorders of pregnancy are among the leading causes of maternal morbidity and mortality, contributing significantly to the national maternal mortality ratio. Studies in Ugandan referral hospitals report preeclampsia prevalence ranging from 4% to 10%, with a notable proportion of women developing persistent hypertension after delivery [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. However, structured postpartum surveillance is inconsistent, and long-term complications such as chronic kidney disease and stroke are likely underdiagnosed. This creates a silent but growing burden of non-communicable disease originating from pregnancy-related conditions.\\u003c/p\\u003e \\u003cp\\u003eThe problem, therefore, is not merely the occurrence of preeclampsia, but the failure to recognize and manage its long-term consequences. Persistent postpartum hypertension is frequently overlooked or misclassified, leading to delayed diagnosis of chronic kidney disease and increased risk of catastrophic events such as stroke. In resource-limited settings, this gap is exacerbated by fragmented care systems, lack of follow-up protocols, and limited patient awareness. The transition from an acute obstetric complication to chronic systemic disease is poorly addressed in both clinical practice and public health policy.\\u003c/p\\u003e \\u003cp\\u003eThe rationale for this study is grounded in the need to highlight the continuum between preeclampsia and long-term cardiovascular and renal disease. By examining a case of persistent hypertension following preeclampsia complicated by chronic kidney disease and stroke, this study aims to challenge the prevailing notion that preeclampsia resolves with delivery. It underscores the importance of early identification, structured postpartum follow-up, and long-term risk stratification in affected women. Additionally, it provides context-specific insight relevant to Uganda, where the burden is high but longitudinal care remains inadequate. This case serves as a clinical and public health reminder that failure to act in the postpartum period carries significant and preventable consequences.\\u003c/p\\u003e\"},{\"header\":\"CASE PRESENTATION\",\"content\":\"\\u003cp\\u003eNakasi Sarah, a 41-year-old multiparous woman, presented initially during her recent pregnancy at approximately 34 weeks\\u0026rsquo; gestation with severe preeclampsia, characterized by persistent blood pressure readings above 160/110 mmHg, significant proteinuria, and visual disturbances. She was managed at a referral facility and underwent induced vaginal delivery due to worsening maternal condition. Although she stabilized postpartum, her blood pressure remained elevated at discharge, and no structured follow-up was maintained.\\u003c/p\\u003e \\u003cp\\u003eTwelve weeks after delivery, she developed sudden onset right-sided weakness and difficulty speaking, without associated trauma or seizures. She was admitted and clinically diagnosed with an acute ischemic stroke, which was confirmed on neuroimaging as a left hemispheric infarction. She received supportive management, antihypertensive therapy, and physiotherapy. Partial neurological recovery was achieved; however, she was discharged with residual right-sided hemiparesis and persistent hypertension.\\u003c/p\\u003e \\u003cp\\u003eOver the following months, she continued to experience poorly controlled blood pressure, progressive fatigue, and intermittent lower limb swelling. Six months after the stroke, she re-presented with worsening symptoms, including reduced urine output and generalized weakness. On evaluation, her blood pressure remained elevated at 220/110 mmHg. Neurological examination showed residual right-sided weakness (power 3/5) with increased tone and reflexes.\\u003c/p\\u003e \\u003cp\\u003eLaboratory investigations at this stage revealed markedly deranged renal function, with a serum creatinine of 8.6 mg/dL (approximately 760 \\u0026micro;mol/L) and an estimated glomerular filtration rate (eGFR) of 10 mL/min/1.73 m\\u0026sup2;, consistent with end-stage chronic kidney disease. She also had hyperkalemia and metabolic acidosis. Urinalysis showed persistent proteinuria. Renal ultrasound demonstrated bilaterally shrunken kidneys with reduced cortical thickness, confirming chronicity.\\u003c/p\\u003e \\u003cp\\u003eGiven the severity of renal impairment, she was initiated on maintenance hemodialysis. Antihypertensive therapy was optimized using a combination of agents, and she was continued on antiplatelet therapy for secondary stroke prevention. She remains on regular dialysis with ongoing multidisciplinary follow-up.\\u003c/p\\u003e \\u003cp\\u003eThis case demonstrates a progressive and severe trajectory of disease, where preeclampsia was followed by persistent hypertension, subsequent stroke at 12 weeks postpartum, and eventual progression to end-stage renal disease within months. The sequence is clinically plausible but represents a failure of early intervention, particularly in the postpartum period, where persistent hypertension was neither adequately controlled nor closely monitored.\\u003c/p\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eOur findings demonstrate persistent postpartum hypertension following preeclampsia, complicated by progression to chronic kidney disease and occurrence of stroke within a short postpartum interval. The persistence of hypertension beyond 12 weeks postpartum in this patient strongly suggests either unresolved vascular dysfunction or the unmasking of pre-existing cardiometabolic susceptibility. The rapid evolution to end-organ complications further indicates that preeclampsia in this case was not a transient insult but part of a broader systemic vascular pathology.\\u003c/p\\u003e \\u003cp\\u003eThese findings are consistent with existing literature demonstrating that women with a history of preeclampsia have a significantly increased risk of developing chronic hypertension. A systematic review by Bellamy et al. reported a fourfold increased risk of later hypertension among women with prior preeclampsia [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. Similarly, Brown et al. showed that preeclampsia is associated with a two- to fourfold increased risk of future cardiovascular disease, including stroke [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. The occurrence of stroke in the early postpartum period in this patient aligns with evidence that the risk of cerebrovascular events remains elevated in the weeks following delivery, particularly in women with severe hypertensive disorders.\\u003c/p\\u003e \\u003cp\\u003eThe progression to chronic kidney disease observed in this case is also well supported in the literature. Vikse et al. demonstrated that women with preeclampsia have an increased long-term risk of end-stage renal disease, particularly in cases of\\u003c/p\\u003e \\u003cp\\u003esevere or recurrent disease [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. The underlying mechanism is\\u003c/p\\u003e \\u003cp\\u003ethought to involve persistent endothelial injury, glomerular endotheliosis, and maladaptive repair processes leading to permanent nephron loss. While many patients experience resolution of proteinuria postpartum, a subset\\u0026mdash;such as this patient\\u0026mdash;develop sustained renal impairment, suggesting that structural kidney damage had already occurred during pregnancy.\\u003c/p\\u003e \\u003cp\\u003eImportantly, the early onset of these complications in this patient highlights a more aggressive disease trajectory than typically described in high-income settings, where long-term complications often manifest years later. This pattern is not anomalous but reflects disparities in healthcare access and continuity. In sub-Saharan Africa, delayed diagnosis, inadequate blood pressure control, and poor postpartum follow-up contribute to accelerated progression of disease. Nakimuli et al. reported a substantial burden of hypertensive disorders in Ugandan women, with limited postpartum surveillance systems in place [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. This creates a clinical gap where persistent hypertension is neither systematically identified nor adequately managed.\\u003c/p\\u003e \\u003cp\\u003eHowever, it would be analytically weak to attribute all outcomes solely to preeclampsia. The patient\\u0026rsquo;s age (41 years) is itself an independent risk factor for hypertension, stroke, and renal disease. Therefore, preeclampsia should be interpreted as both a disease entity and a marker of underlying vascular vulnerability. This distinction matters: preeclampsia does not \\u0026ldquo;cause\\u0026rdquo; chronic disease in isolation but rather reveals and accelerates pre-existing pathophysiological processes.\\u003c/p\\u003e \\u003cp\\u003eOverall, this case reinforces the growing body of evidence that preeclampsia is a critical entry point into chronic non-communicable disease pathways. The similarity between our findings and existing literature lies not just in the presence of complications, but in the shared pathophysiological continuum linking pregnancy-related hypertension to long-term cardiovascular and renal outcomes. The failure is not in recognizing preeclampsia, but in failing to act on its implications beyond delivery.\\u003c/p\\u003e\"},{\"header\":\"CONCLUSION\",\"content\":\"\\u003cp\\u003eThis case shows that preeclampsia should not be considered a condition that ends with delivery. Persistent postpartum hypertension can lead to serious complications such as chronic kidney disease and stroke, especially when follow-up care is inadequate. The patient\\u0026rsquo;s outcome highlights the need for careful monitoring after delivery, early detection of ongoing hypertension, and timely management to prevent long-term damage. Strengthening postpartum care and increasing awareness among healthcare providers and patients are essential to reduce these preventable complications, particularly in resource-limited settings like Uganda.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthical Approval and Consent to Participate:\\u003c/strong\\u003e\\u003cbr\\u003e\\u0026nbsp;Ethical approval was obtained from Kayunga Regional Referral Hospital with approval number (KRRH/2026/777J). Written informed consent was obtained from the patient for participation in this case report.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for Publication:\\u003c/strong\\u003e\\u003cbr\\u003e\\u0026nbsp;Written informed consent was obtained from the patient for publication of this case report and any accompanying clinical information. All reasonable efforts have been made to protect patient identity and confidentiality.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting Interests:\\u003c/strong\\u003e\\u003cbr\\u003e\\u0026nbsp;The author declares no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding:\\u003c/strong\\u003e\\u003cbr\\u003e\\u0026nbsp;This study received no external funding.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; Contributions:\\u003c/strong\\u003e\\u003cbr\\u003e\\u0026nbsp;Sharmarke khadar jibril was responsible for the conception, data collection, analysis, and writing of the manuscript. The author has read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements:\\u003c/strong\\u003e\\u003cbr\\u003e\\u0026nbsp;The author acknowledges the clinical staff involved in the care of the patient and thanks the patient for consenting to share her case for educational purposes.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eWorld Health Organization (2011) WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. WHO, Geneva\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWorld Health Organization (2019) Trends in maternal mortality: 2000 to 2017. WHO, Geneva\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBrown MC, Best KE, Pearce MS, Waugh J, Robson SC, Bell R (2013) Cardiovascular disease risk in women with preeclampsia: systematic review and meta-analysis. BMJ 347:f6390\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWorld Health Organization (2018) Maternal health in Africa: facts and figures. WHO AFRO, Brazzaville\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eNakimuli A, Nakubulwa S, Kakaire O et al (2016) Hypertensive disorders of pregnancy at a tertiary hospital in Uganda: prevalence and outcomes. BMC Pregnancy Childbirth 16:207\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBellamy L, Casas JP, Hingorani AD, Williams DJ (2007) Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ 335(7627):974\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eVikse BE, Irgens LM, Leivestad T, Skj\\u0026aelig;rven R, Iversen BM (2008) Preeclampsia and the risk of end-stage renal disease. N Engl J Med 359(8):800\\u0026ndash;809\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Preeclampsia, Persistent postpartum hypertension, Chronic kidney disease, Stroke, Maternal health, Cardiovascular risk, Uganda\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-9619187/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-9619187/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003epreeclampsia is a major cause of maternal morbidity and mortality and is increasingly recognized as a precursor to long-term cardiovascular and renal disease. Persistent postpartum hypertension remains underdiagnosed, particularly in low-resource settings, where follow-up is inconsistent. Progression to chronic kidney disease and stroke represents severe but preventable outcomes.\\u003c/p\\u003e\\u003ch2\\u003eCase Presentation:\\u003c/h2\\u003e \\u003cp\\u003eNakasi Sarah A 41-year-old, multiparous presented 12 weeks postpartum with persistent hypertension following a pregnancy complicated by severe preeclampsia. Tweleve weeks after delivery, she developed acute right-sided weakness and aphasia and was diagnosed with an ischemic stroke. On evaluation, she had blood pressure of 220/112 mmHg, bilateral lower limb edema, and residual right-sided hemiparesis. Laboratory findings revealed elevated serum creatinine, reduced estimated glomerular filtration rate, and persistent proteinuria, consistent with chronic kidney disease. Renal imaging showed features of chronic parenchymal damage.\\u003c/p\\u003e\\u003ch2\\u003eManagement and Outcome:\\u003c/h2\\u003e \\u003cp\\u003eShe was managed with combination antihypertensive therapy, including calcium channel blockers and ACE inhibitors, alongside antiplatelet therapy for secondary stroke prevention. Dialysis and physiotherapy were initiated. Partial neurological recovery was achieved, though long-term deficits persisted.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eThis case highlights the progression of preeclampsia beyond pregnancy into chronic systemic disease. Persistent postpartum hypertension is a critical but often neglected condition that can lead to irreversible complications such as chronic kidney disease and stroke. Strengthening postpartum surveillance and long-term risk management is essential, particularly in resource-limited settings.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Post Preeclampsia Persistent HTN Complicated by Cerebrovascular and Renal Injury: Case Report\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-05-12 18:24:58\",\"doi\":\"10.21203/rs.3.rs-9619187/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"646fd981-d081-41ea-b200-9671cd77003b\",\"owner\":[],\"postedDate\":\"May 12th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[{\"id\":67964026,\"name\":\"Internal Medicine\"}],\"tags\":[],\"updatedAt\":\"2026-05-12T18:24:59+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-05-12 18:24:58\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-9619187\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-9619187\",\"identity\":\"rs-9619187\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}