Regular BP monitoring during postpartum period prevents Delayed initiation of Antihypertensives and CV risk: JAMA

This cohort study involving 784,782 women revealed that the use of antihypertensive medications postpartum was higher among those with severe hypertensive disorders of pregnancy (HDP), early diagnosis, and prior antenatal medication use.

"Within two years of delivery, up to 44.1% of women with HDPs and 1.8% of those with normotensive pregnancies began medication. Notably, 24.9% of women with HDPs and 76.7% of women with normotensive pregnancies initiated treatment more than three months postpartum," the researchers reported.

Women who experience HDP are known to face a well-documented risk of developing chronic hypertension within a few years after delivery; however, the management of postpartum hypertension in these individuals remains inconsistent. Considering this, Frederikke Lihme, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark, and colleagues aimed to evaluate the frequency of initiating antihypertensive medication within the first two years postpartum, considering both HDP status and prior use of antihypertensives during pregnancy.

This Danish register-based cohort study analyzed data from women who had at least one pregnancy lasting 20 or more gestational weeks and delivered between January 1, 1995, and December 31, 2018, focusing only on their first pregnancy within this period. Statistical analysis was performed from October 2022 to September 2023.

The study investigated hypertensive disorders of pregnancy as the exposure and assessed the cumulative incidences and hazard ratios of initiating antihypertensive medication within two years postpartum, across five postpartum time intervals, concerning HDP status and antenatal medication use.

The following were the key findings of the study:

• The cohort included 784 782 women, of whom 4.7% had an HDP (HDP: median age at delivery, 29.1 years; no HDP: median age at delivery, 29.0 years).
• The 2-year cumulative incidence of initiating postpartum antihypertensive treatment ranged from 1.8% among women who had not had HDPs to 44.1% among women with severe preeclampsia who required antihypertensive medication during pregnancy.
• Most women who required postpartum antihypertensive medication after an HDP initiated use within three months of delivery (severe preeclampsia, 86.6%; preeclampsia, 75.3%; and gestational hypertension, 75.1%).
• 13.4% of women with severe preeclampsia, 24.7.% of women with preeclampsia, 24.9% of women with gestational hypertension, and 76.7% of those without an HDP first filled a prescription for antihypertensive medication more than three months after delivery.
• Women with gestational hypertension had the highest rate of initiating medication after more than one year postpartum, with 11.6% starting treatment after this period.
• Among women who filled a prescription in the first three months postpartum, up to 55.9% required further prescriptions more than three months postpartum, depending on HDP status and antenatal medication use.

Based on the findings, the researchers stress that heightened awareness among both affected women and healthcare professionals about the elevated risk of chronic hypertension following hypertensive disorders of pregnancy (HDP) is crucial.

"Timely detection and effective management of persistent postpartum hypertension are essential to mitigating the cardiovascular disease risks linked to HDPs. Future research should focus on identifying the most effective strategies for delivering this care," the authors concluded.

Reference:

Lihme F, Basit S, Thilaganathan B, Boyd HA. Patterns of Antihypertensive Medication Use in the First 2 Years Post Partum. JAMA Netw Open. 2024;7(8):e2426394. doi:10.1001/jamanetworkopen.2024.26394