Racial Differences in Postpartum Blood Pressure Trajectories Among Women After a Hypertensive Disorder of Pregnancy

Abstract

Key Points Question Does postpartum blood pressure trajectory after a hypertensive disorder of pregnancy differ by race? Findings In this prospective cohort study that included 1077 women after a hypertensive disorder of pregnancy, blood pressure trajectories evaluated using mixed-effects linear regression models differed significantly by self-reported race. At the conclusion of the study, 68% of Black women and 51% of White women met the criteria for stage 1 or stage 2 hypertension. Meaning This study suggests that postpartum blood pressure trajectories indicate persistence of higher blood pressures among Black women in this cohort, which may have important implications for postpartum morbidity and mortality associated with hypertensive and cardiovascular conditions in this population.

Trends in the Incidence of New‐Onset Hypertensive Disorders of Pregnancy Among Rural and Urban Areas in the United States, 2007 to 2019

“…Our results support prior work demonstrating higher rates of hypertensive disorders of pregnancy among non‐Hispanic Black and American Indian/Alaskan Native individuals 31 , 32 and a larger body of work reporting racial and ethnic differences in maternal health. 13 , 33 , 34 Our results further highlight the complex interaction between urbanization, structural racism, and other social determinants of health such as poverty and education in shaping cardiometabolic health. 35 , 36 Future work is needed to investigate the specific risk factors at all ecologic levels, including rurality, that contribute to hypertensive disorders of pregnancy in racial and ethnic groups.…”

Best Practices for Managing Postpartum Hypertension

“…Finally, data on the incidence of postpartum hypertension and trajectories of blood pressures postpartum have historically been limited by loss to follow-up in the postpartum period [ 60 ]. Remote blood pressure monitoring serves as a rich new source of data on blood pressure trajectories postpartum, which may facilitate more nuanced research on the true incidence, phenotypes, and management of postpartum hypertension [ 24 , 32 ].…”

“…Remote blood pressure monitoring serves as a rich new source of data on blood pressure trajectories postpartum, which may facilitate more nuanced research on the true incidence, phenotypes, and management of postpartum hypertension [ 24 , 32 ].…”

“…Among women with either a blood pressure available from a postpartum visit or a reported home blood pressure measurement after 3 weeks postpartum, 53.9% met the criteria for stage 1 hypertension and 19.9% met the criteria for stage 2 hypertension. Though race is a social rather than biologic construct–and thus examination of differences by race demonstrate the impact of racism upon health outcomes rather than any biologic factors–one study has also shown that persistence of higher blood pressures postpartum was more common in Black women compared to White women [ 24 ]. These differences in phenotype and trajectory illustrate potential opportunities for population-based interventions in the postpartum period.…”

Executive summary: Workshop on Preeclampsia, January 25–26, 2021, cosponsored by the Society for Maternal-Fetal Medicine and the Preeclampsia Foundation

“…7 Black women in the United States are at an increased risk of hypertensive disorders of pregnancy, and hypertension and cardiovascular diseases are more frequently associated with morbidity and mortality among Black women than White women. 8 Exposure to systemic racism and discrimination resulting in chronic stress and implicit and explicit biases within the healthcare system leading to inequitable treatment have been posited as contributors to these inequities in health outcomes. 8 Several risk factors for preeclampsia have recently been validated, such as mental health disorders and sleepdisordered breathing: B In the Heart Health 4 Moms study of women with a recent pregnancy complicated by preeclampsia, 15% of participants had probable depression, and 23% endorsed 4 posttraumatic stress disorder (PTSD) symptoms specific to their pregnancy.…”