Postpartum Blood Pressure Phenotypes One Year After Preeclampsia

Objective: To characterize ambulatory blood pressure (BP) phenotypes and nocturnal dipping patterns one year postpartum in women with a history of early-onset preeclampsia or with severe features. Design and method: In this prospective cohort study, women with severe preeclampsia (defined as early-onset preeclampsia or displaying severe features of preeclampsia) during their pregnancy underwent standardized office BP measurement and 24-hour ambulatory BP monitoring (ABPM) between 9–18 months postpartum (one ABPM per participant). Maternal and obstetric characteristics were obtained from medical records and standardized questionnaires. Nocturnal non-dipping (average awake-sleep BP fall < 10%) and BP phenotypes were classified using European Society of Hypertension ABPM definitions. Additionally, a prevention-oriented category of high-normal ABPM was defined, extrapolated from the elevated office BP according to the American College of Cardiology/American Heart Association guidelines, and aligned with European Society of Cardiology prevention guidelines, to represent a high-risk BP phenotype. Logistic regression was used to evaluate determinants associated with postpartum ABPM abnormalities. Results: Among 432 women with complete ABPM-data at median follow up of 13 months, 290 (67%) exhibited an abnormal ambulatory BP-profile. Specifically, 122 (28%) had a high-normal ABPM, 63 (15%) had white-coat hypertension, 41 (9%) had masked hypertension, and 64 (15%) had sustained hypertension, whereas 142 (33%) women were normotensive. Non- or reverse-dipping patterns occurred in 39% of patients. BMI at inclusion (adjusted odds ratio aOR 1.13, 95% CI 1.00–1.28), glycated haemoglobin (aOR 1.08, 95% CI 1.00–1.16), and urine protein-to-creatinine ratio (aOR 1.05, 95% CI 1.01–1.10) were borderline independently associated with abnormal BP, whereas previously diagnosed hypertension showed a strong independent association (aOR 8.45, 95% CI 1.94–37). Conclusions: Nearly two-thirds of women exhibited abnormal ambulatory BP one year after severe preeclampsia, of whom 168 (39%) would have remained undetected by office measurements alone. High-normal ABPM represented the most prevalent abnormal BP phenotype, while adverse nocturnal BP patterns were common, indicating early cardiovascular vulnerability. These findings highlight the added value of ABPM and the elevated BP concept and support their integration into structured postpartum follow-up after preeclampsia.