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Hypertension

Poster Session 2

(601) Evolution of hypertension stages in pregnancy and postpartum from 2013-2022

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

We aimed to assess changes over time in the distribution of ACC/AHA hypertension (HTN) stages during pregnancy and postpartum (PP) from 2013-2022.

Study Design:

This was a retrospective cohort study of pregnancies within one healthcare system. Deliveries from 2013-2022 were analyzed in 2-year intervals. Every blood pressure (BP) was obtained from electronic medical records. Mean systolic (SBP) and diastolic (DBP) BPs were used to classify patients as normotensive (SBP < 120 mm Hg and DBP < 80mm Hg), elevated (SBP 120-129 mm Hg and DBP < 80 mm Hg), stage 1 (SBP 130-139 mm Hg or DBP 80-89 mm Hg), or stage 2 (SBP ≥ 140 mm Hg or DBP ≥90 mm Hg) per the ACC/AHA 2017 HTN guidelines for each of 7 discrete pregnancy periods: 1 = 1st trimester (TM), 2 = 2nd TM, 3 = 3rd TM, 4 = delivery admission to delivery, 5 = delivery to delivery discharge, 6 = up to 6 weeks (early) PP (EPP) and 7 = 6 weeks to 6 months (late) PP (LPP). HTN stages were reported by pregnancy periods and 2-year delivery intervals. Changes in HTN over time were computed.

Results:

A total of 108,924 deliveries from 2013-2022 were included. The percentage of patients with BPs available for the 7 pregnancy periods ranged from 41.2% in the LPP to 99.5% for period 5, but the proportion of patients contributing data did not change across the study. Over the 10-year interval, a decrease in normotensive BP was observed for all periods with largest decreases found in the EPP period from 59.2% in 2013-2014 to 50.4% in 2021-2022 (Δ-8.8%) and the 1st TM from 70.2% in 2013-2014 to 61.9% in 2021-2022 (Δ-8.3%). Elevated BPs and stage 1 HTN increased for every pregnancy period, most notably for elevated BPs in the 2nd TM (15.3% in 2013-2014 to 18.8% in 2021-2022: Δ+2.9%) and for stage 1 HTN in the EPP (17.9% in 2013-2014 to 26.0% in 2021-2022: Δ+8.2%).

Conclusion: The proportion of patients with elevated BPs or stage 1 HTN increased over the study period, with the most profound changes occurring in early pregnancy and early postpartum. Further exploration is needed to assess how maternal attributes may contribute to these observed changes in BP.