Blood pressure control, hypertension phenotypes, and albuminuria: outcomes of the comprehensive Basel Postpartum Hypertension Registry.

Abstract

Postpartum hypertension (PPHT) affects 20% of pregnancies and is strongly correlated to cardiovascular and kidney disease. Most outcome data stems from preeclampsia (PE) neglecting other hypertensive disorders of pregnancy (HDP). This analysis aimed to investigate blood pressure (BP) control, BP phenotypes, therapeutic intensity scores (TIS), and albuminuria across the spectrum of PPHT in the short-medium term.This analysis prospectively followed 370 cases of PPHT. Automated office BP measurements (AOBPM), 24-hour ambulatory BP measurements (24ABPM), TIS and Kidney Disease Improving Global Outcomes (KDIGO) > A2 levels of albumin to creatinine ratio (ACR) were measured at 3 (V3) and 12 (V12) months postpartum. Outcomes were percentage of participants with non-hypertensive AOBPM and awake 24ABPM, whitecoat, and masked hypertension, and an A2 ACR at V3 and V12. The Basel-PPHT cohort consisted of 11.9% (n = 44) chronic hypertension, 31.9% (n = 118) gestational hypertension, 55.4% (n = 205) PE, eclampsia or HELLP, and 18.4% (n = 68) de novo PPHT. Antihypertensive medication was prescribed at baseline, V3 and V12 in 85.4% (n = 316), 19.2% (n = 46), and 20% (n = 21). At V12, 9.3% (n = 5) with PE, eclampsia, and HELLP vs 31.4% (n = 16) of the remaining cohort required antihypertensive medication, p = 0.005. Non-hypertensive BP without medication was seen at V3 and V12 in 47.9% (n = 103) and 62.4% (n = 63), respectively. Albuminuria at baseline, V3 and V12 was 84.9% (n = 124), 29.9% (n = 63), and 16.9% (n = 14) respectively. The Basel-PPHT registry identified undertreatment and persistent albuminuria, despite structured management. Importantly, those without preeclampsia also required stricter controls. Therefore, rigorous follow-ups are crucial for enhancing cardiovascular and renal outcomes in this population.