Blood Pressure Profile 1 Year After Severe Preeclampsia
What is the prevalence of hypertension and 24-hour blood pressure (BP) pattern with ambulatory blood pressure monitoring (ABPM) in women 1 year after severe preeclampsia?
This was a retrospective cohort study of women with severe preeclampsia referred to the Follow-Up Pre-Eclampsia Outpatient Clinic in Erasmus Medical Center, The Netherlands. Women with office BP and ABPM within 9 to 15 months after delivery were studied.
Two hundred women were included. At 1 year post-partum, 41.5% of women had hypertension detected by ABPM (sustained hypertension 14.5%, masked hypertension 17.5%, white-coat hypertension 9.5%). Only 24% of women would have been diagnosed with hypertension using sheer office BP measurement.
There is a high prevalence of hypertension 1 year after severe preeclampsia. ABPM should be offered to all of these women in order to detect masked hypertension and white-coat hypertension.
Women with previous preeclampsia are known to be at increased risk for future development of hypertension and cardiovascular disease (CVD). This study adds to our understanding of women with severe preeclampsia by: (1) demonstrating that a diagnosis of hypertension is common as early as 1 year after delivery; and (2) a substantial number of women with underlying hypertension may only be diagnosed using ABPM, and would potentially be missed by office measurement alone. Despite awareness of preeclampsia as a risk factor for future CVD, few studies have assessed the method, timing, and frequency of post-partum screening. The American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy recommends annual BP, lipid, fasting blood glucose, and body mass index measurement among women with complicated preeclampsia (defined as either recurrent preeclampsia or preeclampsia associated with preterm delivery). The authors of this study suggest that women with a history of severe preeclampsia should be offered ABPM, which seems reasonable. Further studies about the effectiveness of screening and prevention of CVD in this high-risk population are needed.
Keywords: Blood Pressure, Blood Pressure Monitoring, Ambulatory, Hypertension, Masked Hypertension, Postpartum Period, Pre-Eclampsia, Pregnancy, Primary Prevention, Risk Factors, White Coat Hypertension, Women
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