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Hypertension

Poster Session 1

(310) Risk of Hypertension Progression after Pregnancies Complicated by American Heart Association (AHA) Stage 1 Hypertension

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Data on long-term cardiovascular risks of AHA stage 1 chronic hypertension (CHTN) in pregnancy are limited. We quantified the risk of progression to ≥ stage 2 CHTN among patients with stage 1 CHTN in pregnancy.

Study Design: Retrospective cohort study of singleton deliveries at a single US center from 2010- 2022 with at least 2 follow up blood pressures (BP) >12 weeks’ postpartum (PP). Stage 2 CHTN (BP≥140/90mmHg) or anti-HTN medication at index pregnancy were excluded. The primary outcome was progression to stage 2 or higher CHTN (BP ≥140/90mmHg, ≥2 occasions, 4 hours apart) at >12weeks PP or at < 20 weeks’ gestation in a subsequent pregnancy within 5 years. Secondary outcomes included severe CHTN (BP ≥160/110mmHg). Multivariable logistic regression estimated the yearly cumulative odds of outcomes in patients with stage 1 CHTN compared to normal BP, and identified risk factors for progression.

Results: Of 6,184 included patients, 3,871 (62.6%) had normal BPs and 2,313 (37.4%) had stage 1 CHTN during the index pregnancy. Patients with stage 1 CHTN were older, more likely to be White, privately insured, nulliparous, obese, initiate prenatal care earlier and have medical comorbidities. Over 5 years, 622 (26.9%, 95% CI 25.1-28.8%) with stage 1 CHTN had the primary outcome, compared to 502 (13.0%, 95% CI 11.9-14.1%) with normal BP(p< 0.01). Median time to ≥ stage 2 CHTN was shorter in patients with stage 1 CHTN, compared to normal BP (1.7 vs. 1.9yrs, p=0.03). In each successive year after pregnancy, patients with stage 1 CHTN had approximately 2-fold higher adjusted odds of developing ≥ stage 2 CHTN, compared to normal BP(Table). In contrast, the odds of severe CHTN with stage 1 CHTN only increased after 3 years. Black race (OR 1.88, 95% CI 1.52-2.33), obesity (OR 1.88, 95% CI 1.48-2.40), tobacco use (OR 1.56, 95% CI 1.15-2.12) and prior preeclampsia (OR 1.88, 95% CI 1.38- 2.56) were also risk factors for progression.

Conclusion: Pregnant patients with stage 1 CHTN have a significant risk of progression to ≥ stage 2 CHTN as early as the first year postpartum.