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Oral Concurrent Session 4 - Hypertension

Oral Concurrent Sessions

(46) Subtypes of hypertension years after a hypertensive disorder of pregnancy

Wednesday, February 14, 2024
11:15 AM – 11:30 AM  
Location: Potomac Ballroom AB, Ballroom Level
Objective: Isolated diastolic hypertension (HTN) is prevalent in young adults and imparts increased cardiovascular risk. Our objective was to determine whether subtypes of HTN (isolated diastolic, isolated systolic, and combined systolic-diastolic) differ years after index pregnancy complicated by hypertensive disorder of pregnancy (HDP, including preeclampsia, eclampsia, gestational hypertension) compared with normotensive pregnancy.

Study Design: This analysis utilized data from NuMoM2b-Heart Health Study (NuMoM2b-HHS), a multi-site cohort during which 4,312 individuals completed a follow-up visit at 2-7 years postpartum after index delivery (HHS visit). Individuals with preexisting chronic HTN or diabetes or on antihypertensive medications at HHS visit were excluded from this analysis. Combined HTN was defined as systolic blood pressure (SBP) ≥ 130 mmHg and diastolic BP (DBP) ≥ 80 mmHg; isolated systolic or diastolic HTN was either SBP ≥ 130 or DBP ≥ 80 mmHg, respectively. Multinomial logistic regression models adjusted for age, BMI at HHS visit, years from index delivery until HHS visit, and self-reported race and ethnicity (social constructs).

Results: 4,303 individuals met inclusion criteria and had BP measurement at HHS visit with mean of 3.2 (SD 0.9) years since index pregnancy; 950 (22.1%) had history of HDP during that pregnancy. Among 847 (19.7%) with HTN at HHS visit and not on medications, isolated diastolic HTN was the predominant subtype (651 cases; 76.9%), followed by combined HTN (167; 19.7%) and isolated systolic HTN (29; 3.4%). When compared to those without HDP, those with history of HDP had an increased risk of isolated diastolic and combined HTN subtypes (isolated diastolic: aRR 1.58 [CI 1.30, 1.92]; isolated systolic: aRR 1.85 [0.85, 4.03]; systolic-diastolic: aRR 2.70 [1.95, 3.74]).

Conclusion: HDP are associated with both isolated diastolic HTN and combined systolic-diastolic HTN; further study in this population on the role of isolated diastolic HTN on future cardiovascular risk is warranted.