(231) Risk Factors for Persistent Hypertension Requiring Anti-Hypertensive Medications Beyond 6 Weeks Postpartum

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Jenny Y. Mei, MD (she/her/hers)

Clinical Assistant Professor
Stanford University
Mountain View, California, United States

Coauthor(s)

Audra Fain, MD (she/her/hers)

Resident Physician
University of California, Los Angeles
Los Angeles, California, United States
KC

Kate Corry-Saavedra, MD

Resident Physician
University of California, Irvine
University of California, Irvine, California, United States
TN

Tina A. Nguyen, MD

Assistant Professor
University of California, Los Angeles
Los Angeles, California, United States
Thalia Mok, MD

Assistant Professor
University of California, Los Angeles
Los Angeles, California, United States
AM

Aisling M. Murphy, MD

Assistant Professor
University of California, Los Angeles
Los Angeles, California, United States

Objective: Hypertensive disorders of pregnancy increase risk for developing chronic hypertension. We evaluate risk factors for persistent hypertension at 6 weeks postpartum requiring continuation of anti-hypertensive (anti-HTN) medication.

Study Design: A retrospective cohort study of birthing patients with peripartum hypertension (HTN) at a quaternary care center over 2 years. This study is part of an ongoing postpartum quality improvement project that entails lower BP targets and universal remote BP monitoring. Inclusion criteria were delivery at the study institution, prescription of anti-HTN at some point postpartum, and having BP data at 6 weeks postpartum. Primary outcome was continuation of anti-HTNs past 6 weeks postpartum. We compared maternal and hypertensive risk factors between groups.

Results: Out of 6410 deliveries between April 2022-April 2024, 2019 (31.5%) were affected by HTN disorder of pregnancy, of which 775 (38.4%) met inclusion criteria. Total 211 (27.2%) patients were continued on anti-HTNs past 6 weeks. After adjusting for cesarean delivery and patients on anti-HTN entering pregnancy, we found significantly higher odds of continuing anti-HTN past 6 weeks with non-Hispanic Black race (adjusted odds ratio [aOR], 2.97; 95% confidence interval [CI], 1.91-4.62; p< 0.001), prenatal aspirin use (aOR, 1.43; 95% CI, 1.00-2.05, p=0.048), and having public or no insurance (aOR, 1.66; 95% CI, 1.09-2.53, p=0.02). Other risk factors included preeclampsia with severe features (aOR, 1.62; 95% CI, 1.12-2.34, p=0.01), taking more than one anti-hypertensive (aOR, 2.80; 95% CI, 1.76-4.45; p< 0.001), requiring anti-HTN adjustment (aOR, 1.96; 95% CI, 1.37-2.79, p< 0.001), and postpartum ED visit or readmission (aOR, 2.45; 95% CI, 1.17-5.11, p=0.02). Compliance with remote BP monitoring had lower odds of persistent HTN (aOR, 0.23; 95% CI, 0.07-0.79; p=0.02).

Conclusion: Rates of persistent HTN requiring anti-HTN past 6 weeks postpartum are notable with certain patient cohorts at significantly higher risk. Continued intervention is needed to lower future cardiovascular morbidity in these high-risk groups.