Black women at higher risk of postpartum high BP compared to white women: JAMA

This study is published in the Jama Network.

Maternal morbidity and mortality are increasing in the United States, most of which occur post partum, with significant racial disparities, particularly associated with hypertensive disorders of pregnancy. Blood pressure trajectory after a hypertensive disorder of pregnancy has not been previously described.

Hence, Alisse Hauspurg and associates from the Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania condicted this study to describe the blood pressure trajectory in the first 6 weeks post partum after a hypertensive disorder of pregnancy and to evaluate whether blood pressure trajectories differ by self-reported race.

The authors evaluated a total of 1077 women with a mean age of 30.2 years out of which 804 of 1017 were White [79.1%] and 213 of 1017 were Black [20.9%]. Women with a clinical diagnosis of a hypertensive disorder of pregnancy were enrolled in a postpartum remote blood pressure monitoring program at the time of delivery and were followed up for 6 weeks. Mixed-effects regression models were used to display blood pressure trajectories in the first 6 weeks post partum.

The following findings were observed-

a. Systolic and diastolic blood pressures were found to decrease rapidly in the first 3 weeks post partum, with subsequent stabilization (at 6 days post partum).

b. A significant difference was seen in blood pressure trajectory by race, with both systolic and diastolic blood pressure decreasing more slowly among Black women compared with White women.

c. At the conclusion of the program, 126 of 185 Black women (68.1%) compared with 393 of 764 White women (51.4%) met the criteria for stage 1 or stage 2 hypertension (P < .001).

Therefore, the researchers found that "in the postpartum period, blood pressure decreased rapidly in the first 3 weeks and subsequently stabilized."

The study also found that, compared with White women, Black women had a less rapid decrease in blood pressure, resulting in higher blood pressure by the end of a 6-week program.

Given the number of women with persistent hypertension at the conclusion of the program, these findings also appear to support the importance of ongoing postpartum care beyond the first 6 weeks after delivery.

This study suggests that postpartum blood pressure trajectories indicate persistence of higher blood pressures among Black women in this cohort, which may have important implications for postpartum morbidity and mortality associated with hypertensive and cardiovascular conditions in this population.

For further reference log on to:

JAMA Netw Open. 2020;3(12):e2030815. doi:10.1001/jamanetworkopen.2020.30815