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Hypertension

Poster Session 4

(1153) Progression in AHA stage of hypertension and cardiovascular disease risk among ACOG-defined normotensive individuals

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: Antenatal and postpartum hypertension (HTN) are associated with long-term cardiovascular disease (CVD) risk. We aimed to analyze the prevalence of worsening blood pressure (BP) during low-risk pregnancies and implications for long-term CVD risk.

Study Design: This retrospective study included singleton pregnancies and excluded those with CVD, diabetes, renal disease, chronic HTN as defined by ACOG, or using anti-HTN medication antenatally (AN: prior to gestation or < 20w gestation). Participants were categorized as Normal, Elevated, or Stage 1 HTN AN based on AHA guidelines, and again categorized postpartum (PP, measured at 6-12 months), with additional categories of Stage 2 HTN and use of anti-HTN medication. The exposure was persistent or worsening HTN (PWH), defined as unchanged not-normotensive category when comparing AN and PP BP, worsening in category of HTN when comparing AN and PP BP, or using an anti-HTN medication PP. The comparison group was those who remained normotensive or had improved BP PP. The primary outcome was prevalence of high lifetime CVD risk at 6-12 months PP. Prevalence of metabolic syndrome and 30-year CVD risk scores were also calculated. Outcomes were compared using chi-squared or Mann-Whitney U tests.

Results: Of 485 participants, 186 (38.4%) had worsening AHA Stage of HTN at 6-12 months PP and 72 (14.8%) had persistently abnormal BP (Table), so that 53.2% of the cohort had the exposure of PWH. Those with PWH were more likely to have high BMI (28.8 [24.0-34.6] vs. 24.5 [21.9-28.5]; p< 0.01) and a HTN disorder of pregnancy (90.7% vs. 64.8%; p< 0.01). Participants with PWH were more likely to have high lifetime risk of CVD (79.3% vs. 37.8%; p< 0.01). Participants with PWH had higher prevalence of metabolic syndrome and higher 30-year CVD risk scores (Table).

Conclusion: Blood pressure worsened in a high fraction of participants after "low-risk" pregnancies: more than a third progressed in AHA Stage of HTN. Those with persistently abnormal or worsening BP at 6-12 months PP are at significantly elevated risk of long-term CVD and may benefit from targeted postpartum follow-up.