Women with past hypertensive disorders of pregnancy had increased odds of incident hypertension compared to those with gestational diabetes only (adjusted-OR 5.26; 95% CI 1.07-32.76; p=0.05).
Observational (n=156)
No
Does 24-hour ambulatory blood pressure monitoring and management at a specialized Women's Heart Clinic improve detection and control of hypertension in women with past pregnancy complications?
Women with past hypertensive disorders of pregnancy have a high incidence of hypertension that can be effectively detected with 24-hour ambulatory monitoring and managed in a specialized Women's Heart Clinic.
Effect estimate: adjusted-OR 5.26 (95% CI 1.07-32.76)
p-value: p=0.05
OBJECTIVE: To evaluate the incidence of hypertension and blood pressure (BP) phenotypes using 24-hour ambulatory BP (24hr-ABP) in women with past pregnancy complications who were recruited into a Women's Heart Clinic (WHC). STUDY DESIGN: We recruited 156 women aged 30-55 years with past hypertensive disorders of pregnancy (HDP) and/or gestational diabetes (GDM) to a multidisciplinary six-month WHC that provided cardiovascular risk management in Melbourne, Australia. Women were referred for 24 hr-ABP monitoring if clinic BP was ≥130/80 mmHg. MAIN OUTCOME MEASURES: Primary outcome was incident hypertension, defined by 24 hr-ABP monitoring as daytime hypertension ≥135/85 mmHg, nocturnal hypertension ≥120/70 mmHg, and/or 24hr-average hypertension ≥130/80 mmHg. RESULTS: From 156 women, 54 women underwent 24hr-ABP monitoring (mean age 41.3 ± 4.5 years; 3.9 ± 2.6 years post-partum), with 64.8 % HDP and 45.2 % GDM. Incidence of hypertension was 61.1 % 95 % CI 48.2 %-74.0 %. Higher proportion of women with past HDP had daytime hypertension compared to those with GDM only (57.1 % vs. 26.3 %; p = 0.05) and higher nocturnal mean systolic-BP 116.0 ± 11.2 mmHg vs. 109.6 ± 8.7 mmHg; p = 0.04. Women with HDP had increased odds of hypertension adjusted-OR 5.26 95 % CI (1.07-32.76); p = 0.05. Following management at the WHC, women diagnosed with hypertension had significantly improved BP control (6.1 % at baseline vs. 75.8 % at six-month follow-up; p < 0.001). CONCLUSION: Women with past HDP had five-fold increased incidence of hypertension, with higher daytime hypertension and nocturnal systolic-BP, compared to women with GDM. After attending WHC, BP control significantly improved. Our findings suggest routine postpartum follow-up with 24hr-ABP monitoring, through a WHC, may be useful in early detection and management of hypertension in these women.
Pant et al. (Mon,) conducted a observational in Past hypertensive disorders of pregnancy and/or gestational diabetes (n=156). 24-hour ambulatory blood pressure monitoring and Women's Heart Clinic management vs. Gestational diabetes only (for HDP comparison) was evaluated on Incident hypertension, defined by 24 hr-ABP monitoring as daytime hypertension ≥135/85 mmHg, nocturnal hypertension ≥120/70 mmHg, and/or 24hr-average hypertension ≥130/80 mmHg (adjusted-OR 5.26, 95% CI 1.07-32.76, p=0.05). Women with past hypertensive disorders of pregnancy had increased odds of incident hypertension compared to those with gestational diabetes only (adjusted-OR 5.26; 95% CI 1.07-32.76; p=0.05).