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Hypertension

Poster Session 2

(378) Development of hypertension within 15 years postpartum by phenotype of preeclampsia

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: Despite the known association between hypertensive diseases of pregnancy (HDP) and later life hypertension (HTN),less is known about how this risk is modified among those with a history of differing phenotypes of preeclampsia (PE), early onset PE diagnosed prior to 34 weeks gestational age (GA) and late-onset PE diagnosed after 34 weeks GA. 

Study Design: Postpartum blood pressure (BP) measurements greater than 2 months after delivery, medications, and diagnoses were abstracted on N=1,165 singleton pregnancies that were part of a prospective birth cohort study at a single institution from 2006-2008. Stage 2 and Stage 1 HTN were defined using the American College of Cardiology (ACC)/American Heart Association (AHA) 2017 classification criteria with at least 2 BP measurements, physician diagnoses, or usage of anti-hypertensive medication. Adjusted Cox proportional hazard models were used to estimate hazard ratios (HR) and 95%CI for the time to diagnosis for Stage1 and Stage 2 HTN within 15 years p</span>ostpartum, in association with a diagnosis of PE or gestational hypertension (gHTN). Potential confounders in adjusted models were identified. Subsequent pregnancy BPs and subjects with chronic HTN were excluded. 

Results: Of the N=1,011 participants, N=311 (30.8%) were diagnosed with Stage 1 and N=205 (20.3%) with Stage 2 HTN within 15 years of delivering. During these pregnancies N=86 (8.5%) and N=53 (5.2%) were diagnosed with PE and gHTN, respectively. There were N=154 (13.2%) participants that were missing electronic medical record follow up. In adjusted Cox proportional hazard models, participants who had PE or gHTN had a 1.76 (95%CI: 1.16, 2.68) and 3.53 (95%CI: 2.12, 5.87) times higher hazard of developing Stage 2 HTN within 15 years post delivery (Table 1). This risk was diminished for developing Stage 1 HTN. When stratifying the hazard of developing Stage 2 HTN by phenotype of PE , late onset PE was significantly associated with an increasing hazard while there was no association with early onset PE. 

Conclusion: The risk of later life HTN differentiates based on PE phenotype as well as HTN classification