Blood pressure patterns during pregnancy and early postpartum in preeclampsia with severe features: predictors of chronic hypertension

Rationale

Women with a history of preeclampsia are at increased risk of chronic hypertension and subsequently cardiovascular disease. Early identification of high-risk patients facilitates personalized interventions to mitigate these risks. Reliable predictors for chronic hypertension after preeclampsia are lacking. This study analyzed blood pressure patterns during pregnancies with preeclampsia in relation to development of chronic hypertension.

Methods

This prospective cohort study included only women with preeclampsia with severe features, treated at the Erasmus Medical Center between 2010 and 2022, who attended a follow-up visit 1 to 3 years postpartum. Maternal characteristics, pregnancy outcomes and blood pressure measurements were collected from hospital records. Blood pressure patterns were analyzed using linear mixed regression models and antihypertensive medication usage was evaluated with standardized defined daily doses.

Results

Among 72 participants, 29 (40 %) developed chronic hypertension, defined as blood pressure >140/>90 mmHg or antihypertensive medication use at follow-up (mean 1.78 years postpartum). Significant blood pressure differences were observed between weeks 8 and 24 of pregnancy peaking at week 18, where systolic blood pressure averaged 131 mmHg [95 % CI 127–134] in women with chronic hypertension at follow-up, versus 117 mmHg [114–120] in those without. Furthermore, women who developed chronic hypertension used higher antihypertensive dosages during pregnancy (3.8 [95 % CI 2.9–5.6] vs. 2.6 [1.5–3.7]).

Conclusion

A higher blood pressure before 24 weeks of pregnancy is significantly associated with chronic hypertension after preeclampsia. These findings suggest a role for blood pressure patterns in postpartum risk assessment, enabling personalized follow-up for women at increased risk for chronic hypertension.