دورية أكاديمية
Blood pressure changes in gestational hypertension, preeclampsia, and chronic hypertension from preconception to 42-day postpartum.
| العنوان: | Blood pressure changes in gestational hypertension, preeclampsia, and chronic hypertension from preconception to 42-day postpartum. |
|---|---|
| المؤلفون: | Palatnik A; Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: apalatnik@mcw.edu., Mukhtarova N; Department of Obstetrics & Gynecology, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA., Hetzel SJ; Department of Biostatistics and Medical Informatics, University of Wisconsin - Madison, Madison, WI, USA., Hoppe KK; Department of Obstetrics & Gynecology, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA. |
| المصدر: | Pregnancy hypertension [Pregnancy Hypertens] 2023 Mar; Vol. 31, pp. 25-31. Date of Electronic Publication: 2022 Dec 05. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: Netherlands NLM ID: 101552483 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2210-7797 (Electronic) Linking ISSN: 22107789 NLM ISO Abbreviation: Pregnancy Hypertens Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Amtserdam : Elsevier |
| مواضيع طبية MeSH: | Hypertension, Pregnancy-Induced* , Pre-Eclampsia* , Hypertension*, Pregnancy ; Humans ; Female ; Blood Pressure ; Antihypertensive Agents/therapeutic use ; Postpartum Period |
| مستخلص: | Objective: To investigate blood pressure changes from preconception to 42-day postpartum in patients with gestational hypertension, preeclampsia, and chronic hypertension. Study Design: Secondary analysis of patients diagnosed with a hypertensive disorder of pregnancy (HDP) antenatally or postpartum, who were enrolled prospectively in a postpartum remote blood pressure (BP) monitoring program between March 2017 and May 2020. BP were collected at 47 time points: preconception, each trimester, delivery day, and every postpartum day through 42-days postpartum. The primary outcome of the study was to examine changes in BP over time and between the types of HDP for 42 days postpartum. Secondary outcomes included the difference in timing of BP stabilization (BPs < 140/90 mmHg for ≥ 48 h), BP resolution (stabilized without antihypertensive medication use), and antihypertensive medication usage at 42-day postpartum between the HDP groups. Results: A total of 1,194 patients were included in the cohort; 224 (18.8 %) had chronic hypertension (CHTN), 525 (43.9 %) had gestational hypertension (GHTN), 153 (12.8 %) had preeclampsia, and 292 (24.5 %) had preeclampsia with severe features. Postpartum BP peaked on days 5-7 postpartum with rapid decrease from postpartum day 7 until postpartum day 14, followed by very small resolution/stabilization in BP values between day 15 and 42 postpartum. By 6 weeks postpartum, 60.5 % of patients with CHTN still required antihypertensive medications to maintain BP < 140/90 mmHg. In the group of patients with preeclampsia with severe features, 32.6 % still required antihypertensive medications to maintain BP < 140/90 mmHg. Finally, 16.1 % patients with GHTN and 23.8 % of patients with preeclampsia without severe features required antihypertensive use at 6 weeks postpartum. The groups of CHTN and GHTN had significant reduction in SBPs at 42-days postpartum compared to their pre-conception BP (p < 0.001 for both groups). While diastolic BP at 42-days postpartum were not different in CHTN, GHTN and preeclampsia groups, compared to preconception, women with preeclampsia with severe features had higher diastolic BP at the end of 6-weeks postpartum period compared to preconception readings (p = 0.007). Conclusion: Our study adds new information by examining BP trajectories through 42 days postpartum and demonstrates that all types of HDP are at risk of BP spikes and intervention through 42 days postpartum. We found that patients with CHTN had slower stabilization and resolution of their BP compared to patients with GHTN and preeclampsia with and without severe features. In addition, even at 42 days postpartum, a substantial proportion of patients with HDP, including GHTN, required antihypertensive treatment to maintain BP within stage I hypertension. Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (Copyright © 2022 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Postpartum; Preeclampsia with severe features; Pregnancy; Resolution; Stabilization |
| المشرفين على المادة: | 0 (Antihypertensive Agents) |
| تواريخ الأحداث: | Date Created: 20221213 Date Completed: 20230227 Latest Revision: 20230227 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1016/j.preghy.2022.11.009 |
| PMID: | 36512857 |
| قاعدة البيانات: | MEDLINE |
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