Ongoing hypertension is highly prevalent and associated with emergency department visits and readmissions after delivery.

Many women who suffer a hyper­tensive disorder of pregnancy continue to have hypertension after delivery. To examine the prevalence and outcomes of ongoing hypertension in this setting, investigators performed a cohort study in 2705 women without prepregnancy hypertension who suffered a hypertensive disorder during pregnancy (pre-­eclampsia or gestational hyper­tension). These women were enrolled in a remote postpartum ambulatory blood pressure (BP) monitoring program at a single hospital system. The primary out­comes were readmissions and emergency department visits within the first six weeks postpartum.

Results were as follows:

• after hospital discharge, 2214 women (82%) had persistent hypertension (any home BP 140/90 mmHg or higher or treatment with an antihypertensive medication), and 382 (14%) developed severe hypertension (any home BP 160/110 mmHg or higher)
• initiation of antihypertensive medication occurred in approximately 47% of women – about half before discharge and half after discharge
• women with severe and nonsevere persistent hypertension had the highest rates of postpartum emergency department visits (16% and 12%, respectively) and hospital readmissions (13% and 4%, respectively) compared with women with normalised postdischarge BP (8% and 3%, respectively)
• in multivariate analyses, severe, persistent hypertension was associated with approximately doubled odds of an emergency department visit and approximately sevenfold higher odds of hospital readmission compared with normalised postdischarge BP.

Comment: These data show that most women with a hypertensive disorder of pregnancy will continue to have persistent hypertension for at least six weeks post­partum, but from my personal experience many of these women may indeed normalise with longer follow up (three or six months). However, the critically important point is that we follow these women closely so we do not miss which patients actually progress to chronic hypertension.

Karol E. Watson, MD, PhD, FACC, John C. Mazziotta, MD, PhD, Term Endowed Chair and Professor of Medicine/Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, USA.

Hauspurg A, et al. Postpartum ambulatory blood pressure patterns following new-onset hypertensive disorders of pregnancy. JAMA Cardiol 2024 Jun 12; e-pub (https:// doi.org/10.1001/jamacardio.2024.1389).

This summary is taken from the following Journal Watch title: Cardiology.