Severe pre-eclampsia a risk factor for post-pregnancy hypertension
Women diagnosed with severe pre-eclampsia have an elevated risk for developing hypertension 1-year post-pregnancy, according to results of a study from the Netherlands.
“Our findings suggest women who have high BP during pregnancy should continue to monitor their BP long after they’ve delivered their babies. It’s not only important to monitor BP in the doctor’s office, but also at different times of the day and night, at home,” said study author Dr Laura Benschop from the Erasmus Medical Center, Rotterdam, the Netherlands.
In this retrospective cohort study, 200 women (mean age at index pregnancy 31.6 years, 83 percent Caucasian, 14.6 percent with pre-existing hypertension) who had previously been diagnosed with severe pre-eclampsia underwent ambulatory blood pressure monitoring (ABPM) and office BP measurements up to 1 year after delivery. ABPM was measured every 30 minutes during the day and every 60 minutes at night over a 24-hour period.
Based on ABPM, 41.5 percent of women previously diagnosed with severe pre-eclampsia had hypertension 1 year after delivery, be it sustained (14.5 percent), masked (17.5 percent), or white-coat hypertension (9.5 percent). [Hypertension 2018;71:491-498]
When assessed using office BP measurement, just 24.0 percent of the women would have been deemed hypertensive.
“We’ve shown here that high BP comes in many forms after pregnancy. Women who know their numbers can take the proper steps to lower their BP and avoid the health consequences of high BP later in life,” said Benschop.
Pre-pregnancy hypertension and first trimester body mass index (BMI) were tied to an elevated risk of post-pregnancy hypertension, where pre-existing hypertension (as measured by ABPM) was associated with an increased risk of daytime hypertension (odds ratio [OR], 2.8, 95 percent confidence interval [CI], 1.0–7.7; p=0.048), office hypertension (OR, 3.1, 95 percent CI, 1.0–9.3; p=0.042), and sustained hypertension (OR, 7.5, 95 percent CI, 1.7–32.0; p=0.007), while first trimester BMI was associated with an elevated risk of office hypertension (OR, 1.1, 95 percent CI, 1.0–1.2; p=0.04).
There was also a disadvantageous dipping pattern (systolic night-to-day BP ratio) identified in 45.6 and 45.3 percent of women with normotensive and hypertensive daytime BP, respectively, as measured by ABPM.
“[P]rogression toward a disadvantageous dipping pattern [from dipping to nondipping to reverse dipping pattern] … progressively increases the risk of future [cardiovascular disease (CVD)] by inducing subclinical target organ damage,” said the researchers, highlighting that diagnosing a disadvantageous dipping pattern requires the use of ABPM.
“Current clinical guidelines on the prevention of CVD and stroke after a hypertensive pregnancy disorder lack advice on ABPM after delivery. We think that ABPM should be offered to all women who experienced severe pre-eclampsia for more accurate BP assessment. By doing so, hypertension management can be improved, which eventually might reduce the risk of future CVD,” said the researchers.
“The problem is high BP after pregnancy often goes unnoticed because many of these women have normal BP readings in the doctor’s office,” said Benschop.
“[W]e show that ABPM after severe pre-eclampsia provides important additional information aside of office BP,” said Benschop and co-authors.
Limitations included the predominantly Caucasian and higher educated study population which may reduce the generalizability of the findings to all women previously diagnosed with severe pre-eclampsia. One-time measurement of BP may also have affected BP accuracy, they said.