IMPACT OF PRE-ECLAMPSIA ON PERSISTENT HYPERTENSION IN A LOW RESOURCED SETTING

Objective: Hypertensive disorders of pregnancy (HDP) affect about 10% of all pregnant women. Systematic reviews of prevalence and incidence of pre-eclampsia in Africa, report much higher proportions compared to global averages. There is a growing body of literature on the long-term target organ damage following HDP. The commonest long-term complication is early onset hypertension. Furthermore, international data have demonstrated a clear association of HDP with an increased risk of future cardiovascular disease and metabolic derangement. We aimed to determine the proportion of women with persistent hypertension following severe pre-eclampsia in an African setting. Design and method: This was a prospective cohort follow-up study that assessed women after pre-eclampsia. Women were recruited on attendance at the Post-partum Hypertension Service. They gave signed informed consent to be included in a prospective registry. Data captured on the registry included demographics, delivery details and data at first visit and annual follow-up. The data from the registry were analysed. Results: 241 women, with a median age of 30 years, presented to the first follow-up visit between 6 weeks and 12 months post-partum. Pre-eclampsia was complicated by acute kidney injury in 50% of patients, liver injury in 50%, haematological complications in 51% and very early delivery (<34 weeks) in 65%. There was a high proportion of stillbirths (24%). At the first visit, 52% of women had persistent hypertension, but 44% of those who did not have hypertension before their pregnancy developed hypertension, and 60% at the annual visit. Metabolic syndrome was present in 33% of women at first visit and in 34% at annual follow up. Albuminuria was present in 55% and impaired kidney function in 22% at the first visit. Sustained post-partum hypertension was associated with acute kidney injury at the time of delivery, a higher body mass index and an older age at delivery. There was a positive correlation between maternal age and annual blood pressure. Conclusions: Persistent hypertension was high in this young post-partum cohort of women who had severe pre-eclampsia. Maternal age, weight and acute kidney injury were predictors of sustained hypertension.