HYPERTENSION during pregnancy, is known to pose significant risks to maternal health. However, less is known about how varying patterns of blood pressure during pregnancy can affect the risk of hypertension later in life. A recent study focused on identifying distinct systolic blood pressure (SBP) trajectories and examining their association with hypertension risk up to 5 years postpartum. Researchers found that certain blood pressure patterns during pregnancy, particularly consistently elevated levels within a clinically normal range, were linked to a higher risk of postpartum hypertension.
Data was gathered from the MADRES cohort, including 854 pregnant individuals from early pregnancy to 5 years postpartum. Participants were split into three distinct SBP trajectory groups: consistently low (n=685; 80.2%), consistently elevated (within the normal clinical range, n=106; 12.4%), and high–drop–high, characterised (higher blood pressure levels and gestational hypertension or preeclampsia, n=63; 7.4%). Participants’ blood pressure measurements were taken at multiple points throughout pregnancy (4–8, 20–24, and 37–41 gestational weeks), and postpartum hypertension was tracked via interviews and measurements.
Results revealed that consistently low SBP was associated with the lowest risk of postpartum hypertension. Those with a consistently elevated SBP experienced a nearly 5-times greater risk of (adjusted hazard ratio [aHR] 4.91; 95% CI: 2.01–12.0). The high–drop–high demonstrated even greater increased risk of postpartum hypertension (aHR 5.44; 95% CI: 1.89–15.7). Furthermore, across the groups from consistently low to consistently elevated to high–drop–high, researchers observed an increased risk of preterm birth, preeclampsia, gestational hypertension and Type 2 diabetes, with the greatest risk of gestational diabetes seen in the consistently elevated group. These findings suggest that subclinical elevations in blood pressure during pregnancy can significantly increase the risk of long-term hypertension.
In conclusion, this study highlights the importance of recognizing blood pressure patterns during pregnancy as a tool for identifying individuals at risk of developing hypertension later in life. The consistently elevated trajectory, which often goes unnoticed in clinical practice, represents a group that may benefit from closer monitoring and early interventions, potentially improving long-term cardiovascular health. Limitations of the study include its focus on a predominantly low-income Hispanic population, which may limit generalisability, and the potential for measurement error in blood pressure readings. Further research should explore how these findings can be incorporated into clinical practices for early identification and intervention of at-risk individuals, improving long-term maternal health.
Reference
Niu Z et al. Gestational Blood Pressure Trajectories and 5-Year Postpartum Hypertension Risk in the MADRES Study. JACC Adv. 2025;DOI: 10.1016/j.jacadv.2025.101660
