(1082) Resolution of postpartum hypertension among Asian, Black, and Hispanic patients with hypertensive disorders of pregnancy

Persistent postpartum hypertension is a risk factor for maternal morbidity and future cardiovascular disease. We sought to (1) evaluate the time to resolution (TTR) of hypertension among patients with a hypertensive disorder of pregnancy (HDP) and (2) determine which characteristics were associated with resolution in a cohort of high-risk patients.

Study Design:

We conducted a secondary analysis of a prospective cohort study of Asian, Black, and Hispanic patients who delivered from April-October 2022 at 4 hospitals in Philadelphia and New York City. Participants reported postpartum blood pressures (BPs) twice daily through a texting platform until 10 weeks postpartum. We included participants diagnosed with HDP prior to discharge. Resolution of HDP was defined as BP< 140/90 for ³48 hours within 10 weeks postpartum. Survival curves were generated to assess TTR and Cox proportional hazards was used to compute hazard ratios.

Results:

Of 419 patients in the cohort, 120 had HDP and were included. 80 (67%) achieved resolution of HDP. The median TTR among all participants was 7.0 days (SD: 3.4). A higher BMI and higher systolic BP at discharge were associated with a lower rate of resolution (Table). Non-Hispanic Black and “other” race were also associated with a lower rate of resolution compared to Hispanic patients. Participants with a high school degree/GED experienced a lower rate of resolution compared to those with a college degree. When adjusting for confounders (BMI and race and ethnicity), each 1 mmHg increase in systolic BP at delivery resulted in an approximately 2% lower rate of resolution (aHR: 0.98, 95% CI: 0.96, 0.99). Similarly, each 1 mmHg increase in diastolic BP resulted in an approximately 3% lower rate of resolution (aHR: 0.97, 95% CI: 0.95, 0.99).

Conclusion:

In this high-risk cohort of Asian, Black, and Hispanic patients with HDP, BMI, race/ethnicity, education level and BP at discharge were all associated with lower rates of resolution of BP. Given the high maternal morbidity in this group, these factors should be considered when determining length of time for postpartum BP monitoring.