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Hypertension

Poster Session 4

(1169) Postpartum Beat-to-Beat Systolic Blood Pressure Variability in Preeclampsia with Severe Features

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Beat-to-beat blood pressure variability (bbBPV) has been correlated with adverse outcomes including stroke in non-pregnant populations. bbBPV increases throughout healthy pregnancy and to a greater extent in preeclampsia. However, it is unknown whether elevated bbBPV persists in the immediate postpartum period. We compared differences in bbBPV within 8 days postpartum between patients with preeclampsia with severe features (PSF) and normotensive postpartum controls. 

Study Design: We prospectively recruited individuals with P</span>SF and normotensive pregnant individuals delivering at an urban academic medical center. We measured continuous blood pressure over 10 minutes using finger plethysmography within 8 days postpartum. Systolic bbBPV was calculated using spectral analysis in low frequency (LF, 0.04-0.15 Hz) and high frequency (HF, 0.15-0.40 Hz) bands. Results were compared using parametric or non-parametric tests depending on the distribution.

Results: Subjects were 51 women with PSF, of whom 21 (41%) had chronic hypertension with superimposed preeclampsia (siPEC), and 19 normotensive controls. All PSF subjects had been treated at the time of the study; 10 (20%) had received magnesium sulfate (Mg) and 44 (86%) had received antihypertensive medications (antiHTNs) within 24 hours before bbBPV was measured. Subjects with PSF had significantly higher LF (median 12.3 vs. 8.5 mmHg2, p = 0.038) and HF (median 4.8 vs. 3.8 mmHg2, p = 0.029) systolic bbBPV compared to controls. Within the PSF group, bbBPV did not differ in patients who received Mg or antiHTNs within 24 hours of the study. Subgroup analysis showed no difference in bbBPV in the siPEC group compared to control and non-superimposed PSF groups. LF/HF ratio did not differ significantly among groups.

Conclusion: The increase in bbBPV seen in preeclampsia patients during pregnancy persists during the first week postpartum. Standard treatment with Mg and antiHTNs is intended to reduce mean blood pressure but may not address elevated bbBPV in the postpartum period.