Hypertensive disorders of pregnancy, such as preeclampsia and gestational hypertension, are associated with an increased long-term risk of stroke, cognitive decline, and dementia. Previous studies have shown that women with a history of hypertensive pregnancy often have reduced brain volumes later in life, but it has remained uncertain whether improved blood pressure control soon after delivery could influence these brain changes. The current imaging substudy of the POP-HT randomized clinical trial aimed to examine this question.
Led by Winok Lapidaire from the University of Oxford, the study, published in JAMA Neurology, evaluated whether physician-optimized postpartum blood pressure self-management was linked to differences in brain structure compared with usual postnatal care. The POP-HT trial was a prospective, open-label study with blinded end-point assessment conducted at a single tertiary center in the United Kingdom.
Women older than 18 years who had preeclampsia or gestational hypertension requiring antihypertensive treatment at hospital discharge were enrolled. Between February 2020 and November 2021, 220 participants were randomized to either a telemonitored, physician-guided blood pressure self-management program or standard postpartum care. Brain magnetic resonance imaging (MRI) was performed at a mean of nine months postpartum to assess gray matter, white matter, cerebrospinal fluid, and subcortical brain volumes.
The trial revealed the following findings:
- MRI data from 157 participants were analyzed, with 63% having a history of preeclampsia and 37% having gestational hypertension.
- Participants in the intervention group showed significantly larger total white matter volumes compared with those receiving usual postpartum care.
- White matter volume, a marker of brain connectivity and overall brain health, was better preserved in women who received optimized blood pressure management.
- Among women receiving usual care, those with prior preeclampsia had smaller volumes in subcortical brain regions, including the putamen, accumbens, and pallidum, compared with women with gestational hypertension.
- These subcortical regions are involved in motor control, motivation, and cognitive functions.
- The reductions in subcortical brain volumes seen in usual care were not observed in women managed with physician-optimized blood pressure control, indicating a potential protective effect of the intervention.
The findings highlight the early postpartum period as a potential window of opportunity to improve long-term brain health in women who experience hypertensive pregnancy disorders. Optimizing blood pressure control during this critical phase may help reduce the adverse neurological effects associated with preeclampsia.
The authors acknowledge several limitations, including the single-center design, modest sample size, and the exploratory nature of the imaging outcomes. Longer follow-up and larger multicenter studies incorporating cognitive assessments are needed to determine whether these brain volume differences translate into sustained neurological benefits.
"Overall, the study adds to growing evidence that tighter blood pressure control in the immediate postpartum period may support brain health, alongside known cardiovascular benefits, particularly for women with a history of preeclampsia," the authors concluded.
Reference:
Lapidaire W, Kitt J, Krasner S, et al. Brain Volumes After Hypertensive Pregnancy and Postpartum Blood Pressure Management: A POP-HT Randomized Clinical Trial Imaging Substudy. JAMA Neurol. Published online January 05, 2026. doi:10.1001/jamaneurol.2025.5145
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