Women who have a history of hypertensive disorders of pregnancy (HDP) are more at risk for cardiovascular diseases from chronic hypertension (CHT). For a study, researchers sought to evaluate how well peripartum screening can foretell CHT following HDP.

Women with HDP who received peripartum transthoracic echocardiography and were assessed for CHT (blood pressure ≥140/90 mm Hg or taking antihypertensive medication) at least 3 months after delivery participated in the long-term prospective research. The connection between clinical and transthoracic echocardiography data and a postpartum diagnosis of CHT was evaluated using univariable and multivariable models.

About 70 (33.2%) of 211 women had hypertension at the median postpartum follow-up of 124 days (IQR: 103-145 days). Women with CHT differed from normotensive women in that they were older (35.5±5.0 years vs. 32.9±5.6 years; P=0.001), more likely to be of Afro-Caribbean descent (27.1% vs. 7.8%; P<0.0001), had a higher body mass index (33.4±5.9 kg/m2 vs. 31.2±5.4 kg/m2, P = 0.006), and had higher mean arterial pressure (106.5 ± 8.4 mm Hg vs 103.3 ± 7.0 mm Hg; P=0.004). Additionally, compared to normotensive women, they demonstrated significantly higher left ventricular mass index (84.0±17.9 vs. 76.3±14.8 g/m2, P=0.001), higher relative wall thickness (0.46±0.10 vs. 0.40±0.10, P<0.0001), and lower global longitudinal strain (-15.6%± 2.7% vs. -16.6%± 2.2%, P=0.006). Area under the curve: 0.85; 95% CI: 0.79-0.90). A prediction model combining clinical (maternal age and first trimester mean arterial pressure) and echocardiographic (left ventricular mass index >75 g/m2,relative wall thickness >0.42, and E/e′ ratio >7) feature demonstrated excellent accuracy in identifying women with persistent hypertension after HDP.

To prevent cardiovascular disease, the peripartum screening method may be utilized to identify women at risk for CHT who would benefit from extensive blood pressure monitoring and pharmaceutical interventions beginning in the early postpartum period.

Reference: jacc.org/doi/10.1016/j.jacc.2022.07.028