Blood Pressure and Hypertension After Hypertensive Disorders of Pregnancy

Introduction Cardiovascular disease (CVD) is the leading cause of mortality for women. Timely diagnosis of hypertension after a hypertensive disorder of pregnancy (HDP) provides an opportunity for CVD prevention. We assessed the association between blood pressure (BP) 15-90 days postpartum and incident hypertension after an HDP.

This was a retrospective cohort study of women with an HDP between January 2014 and December 2017 at two health systems in the southeastern U.S. Cox proportional hazards models assessed the association of postpartum BP and incident hypertension 12 months postpartum. Covariates included type of HDP, gestational age at diagnosis, timing of measurement, comorbidities, and structural determinants of health. We excluded people with preexisting hypertension and without a BP measurement 15-90 days postpartum.

Out of 5657 women, only 2514 (44%) met the inclusion criteria as almost 40% (2125) did not have a BP check at 15-90 days postpartum. The hazards of incident hypertension were significantly higher for those with elevated systolic postpartum BP (1.70, 95% CI: 1.37 - 2.12) and more severe HDPs. The estimated cumulative incidence of hypertension among participants with postpartum BP of 110/65 mmHg was 4.7% (CI, 2.0% - 7.4%) and for those with BP 140/90, it was 13.0% (CI 5.6% - 19.8%).

The risk of incident hypertension after an HDP is high in the first year postpartum. Despite this, for many participants, BP was not even measured within 15-90 days postpartum despite. Opportunities exist to improve care for individuals with HDPs. Competing Interest Statement The authors have declared no competing interest. Funding Statement The project described was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UM1TR004406. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The IRBs from Duke University, University of North Carolina, and Auburn University approved this study with Duke University IRB being the primary. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Data can be made available upon requests to the authors. Non-Standard Abbreviations and Acronyms - CVD - Cardiovascular Disease - HDP - Hypertensive Disorder of Pregnancy - BP - Blood Pressure - CI - 95% Confidence Interval - ICD-CM 9/10 - International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification - BMI - Body Mass Index - HR - Hazard Ratio