Self-monitoring and physician-optimized antihypertensive titration post-partum decreases BP during the first 9 months

By Leah Kosyakovsky on

Key Points:

  • Up to 1 in 10 women experience a hypertensive disorder of pregnancy, which is associated with long-term cardiovascular disease. However there are no established interventions to reduce risk post-partum.
  • The POP-HT study examined the impact of a targeted physician-optimized postnatal BP control regimen on long-term BP control and cardiac remodeling.
  • Physician-Optimized post-partum BP control resulted in a significant reduction in both systolic and diastolic BP at 9 months, in addition to BP-related postnatal admissions and evidence of adverse cardiac remodeling on both cardiac MRI and echocardiogram.

Hypertensive disorders of pregnancy (HDP) impact 1 in 10 women, and 1/3 of women who develop HDP subsequently develop chronic hypertension within the next decade. Additionally, HDP is associated with increased long-term CVD. However, there have been no established post-partum interventions to reduce the risk of long-term CVD in women with HDP. In a breaking presentation at the 2023 AHA Scientific Sessions today,  Dr. Jamie Kitt (High Wycombe Hospital) and his team presented their study: “Long-Term Blood Pressure Control After Physician Optimized Postpartum Blood Pressure Self-Management, “ or the POP-HT trial.

The POP-HT study (NCT04273854) randomized 220 adult (>18 years) women with either gestational hypertension or pre-eclampsia who required antihypertensive medication at the point of discharge. Relevant exclusion criteria were significant renal or hepatic impairment, life expectancy < 6 months, or pre-existing hypertension. Participants were randomized to either standard NHS post-partum care or the intervention arm, which involved self-monitored BP readings sent via smartphone app to the monitoring physician, with resultant physician-initiated BP medication changes. Participants were followed for 6-9 months, and BP was monitored at baseline, week 1, and week 6. A 24 hour ambulatory BP measurement was taken at the final visit, and a cardiac MRI (CMR) and echocardiogram were also performed. The primary outcome was the 24-hour average diastolic BP at 9 months postpartum. Secondary outcomes included 24-hour average systolic BP at 9 months postpartum, clinic diastolic BP at 9 months postpartum, postnatal readmission, and post-partum CMR/ECHO findings.

The median age was 33, with a mean BMI of 28 and mean BP at first antenatal visit of 117 mm Hg; 60% of the participants had preeclampsia, and the remainder had gestational hypertension. Two hundred participants (91%) were included in the primary analysis. The intervention arm had a significantly reduced 24-hour average diastolic BP at 9 months postpartum (71.2 vs 76.7 mm Hg; between-group difference -5.80mm Hg, 95% CI -7.40, -4.20 mm Hg; p<0.001). There was also a significant reduction in 24-hour average systolic BP at 9 months postpartum (114.0 vs 120.3 mm Hg; between-group difference -6.51mm Hg, 95% CI -8.80, -4.22 mm Hg; p<0.001). There was a significant reduction in BP-related postnatal readmissions (8 vs 29, ARR 20%, NNT 5). There was also a significant reduction in LV mass and a significant increase in both LV and RV systolic function on cardiac MRI in the intervention arm, in addition to a significant reduction in left atrial volume and average E/E’ ratio on echocardiogram (all p<0.001).

When discussing the clinical implications of the study at the Scientific Sessions, Dr. Kitt stated: “In this single-center trial, self-monitoring and physician-guided titration of antihypertensive medications was associated with lower blood pressure during the first 9 months postpartum than usual postnatal outpatient care in the UK…This trial identifies a potential need for a paradigm shift in the way women affected by hypertensive pregnancy are managed postnatally…POP-HT demonstrates a >5 mm Hg diastolic and almost 7 mm Hf systolic BP improvement….if maintained long-term, this could result in a ~20% reduction in lifetime CV risk.”