Background: Hypertensive disorders of pregnancy (HDP) are associated with cardiovascular disease, however patterns of blood pressure recovery are understudied. We compared pregnancy and postpartum blood pressure trajectories among individuals with HDP who developed persistent hypertension at one year postpartum compared to individuals with normalization of blood pressure (BP). Methods: We used data from a randomized clinical trial of overweight and obese individuals with HDP conducted in the first year after delivery. Pregnancy BPs were obtained during prenatal visits, postpartum BPs were prospectively obtained through home monitoring. Demographic characteristics and trajectories were compared by hypertensive status (systolic BP ≥130, diastolic BP ≥80 mmHg or use of anti-hypertensive medications) at one year. We used repeated BP measures to fit separate mixed-effects linear regression models for pregnancy and postpartum using restricted cubic splines. Results: We included 129 individuals who contributed a mean of 95.4 (95%CI 76.7-115.1) BP readings during and following pregnancy. In total, 75 individuals (58%) progressed to hypertension by 1 year postpartum. Individuals with persistent hypertension were older, delivered at earlier gestational ages and had higher BMI at one year postpartum compared to those with normalization. Individuals with persistent hypertension had a more adverse BP trajectory (p<0.01 for systolic and diastolic BP) in the first year postpartum. These differences persisted in multivariable models after adjustment for pre-pregnancy BMI and type of HDP (p<0.01 for systolic and diastolic BP). Conclusions: Blood pressure trajectories in the first year postpartum, but not during pregnancy, may provide critical information for risk stratification after a HDP.

The authors have declared no competing interest.

NCT03749746

This work was supported by the Jewish Healthcare Foundation, Amy Roberts Health Promotion Award, by funds from Magee-Womens Research Institute's Erie initiative, The Erie Community Foundation and Hamot Health Foundation and by NIH/ORWH Building Interdisciplinary Research Careers in Women's Health (BIRCWH) NIH K12HD043441 to AH. Dr Esa Davis is a member of the US Preventive Services Task Force (USPSTF); this article does not necessarily represent the views and polices of the USPSTF.

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