Antihypertensive medications for individuals with hypertensive disorders of pregnancy and incident hypertension

Introduction To evaluate the association between the use of antihypertensive medications during the peripartum period among individuals with hypertensive disorders of pregnancy (HDP) and the risk of incident hypertension in the years after pregnancy. Methods We conducted a secondary analysis of the nuMoM2b‐Heart Health Study (HHS), a multi‐site prospective cohort study that enrolled nulliparous pregnant individuals in their first trimester who were followed during pregnancy and subsequently underwent a cardiovascular screening visit (HHS visit) 2‐7 years after delivery. Individuals without chronic hypertension who developed HDP (gestational hypertension, preeclampsia without severe features, or preeclampsia with severe features) were included. The exposure was treatment with antihypertensive medication (oral or intravenous) during the pregnancy episode (pregnancy through 6 weeks postpartum). The primary outcome was stage 1 (blood pressure [BP] ≥130/80 mmHg) and stage 2 hypertension (BP ≥140/90 mmHg or use of antihypertensive medications) at the HHS visit, which was ascertained following a standardized research protocol. Multinomial logistic regression models estimated the association of antihypertensive medication use with incident hypertension, adjusted for co‐variates. Results Among 4484 individuals who underwent a follow‐up visit (mean follow‐up: 3.2 ± 1.8 years), 1007 (22.5%) had HDP during the nuMoM2b pregnancy and were included. Of those, 132 (13%) were treated with an antihypertensive medication during the pregnancy episode. Treated individuals had higher systolic (119 ± 13 vs. 114 ± 11 mmHg, p < 0.001) and diastolic (80 ± 12 vs. 74 ± 10 mmHg, p < 0.001) BP at follow‐up. In multivariable regression, those treated with antihypertensive medications had 2.5‐fold (95% confidence interval [CI], 1.6–4.1) greater odds of stage 1 hypertension and 4.3‐fold (95% CI, 2.5–7.3) greater odds of stage 2 hypertension compared to those with HDP who were not treated with antihypertensive medications. Conclusion Among nulliparous individuals with HDP, treatment with antihypertensive medication during or immediately after pregnancy is associated with a two‐ to fourfold higher odds of incident hypertension in the years postpartum, independent of HDP type. The use of antihypertensive medication in the peripartum period may serve as an easily ascertainable risk marker to identify individuals at heightened risk of persistent hypertension who may benefit from targeted postpartum surveillance and intervention.