Unmasking hidden cardiovascular risk: masked hypertension, aortic stiffness and cardiac remodeling in women with prior preeclampsia

Preeclampsia (PE) is associated with long-term cardiovascular risk, yet conventional postpartum evaluations often fail to detect early hemodynamic alterations. Masked hypertension (MH) characterized by normal office blood pressure but elevated readings on ambulatory blood pressure monitoring (ABPM)has gained attention as a potential early indicator of cardiovascular dysfunction. This study aimed to determine the prevalence of MH and examine its relationship with aortic stiffness and early cardiac remodeling in postpartum women with a history of PE. This cross-sectional study included 50 women with prior PE and 50 age-matched normotensive controls at least one year postpartum. All participants underwent office BP measurement, 24-hour ABPM, and transthoracic echocardiography. Aortic stiffness index (ASI), aortic strain, left ventricular mass index (LVMI), and diastolic function parameters were evaluated. Logistic regression identified independent predictors of masked hypertension. Masked hypertension was significantly more prevalent in the PE group than controls (38% vs. 20%, p = 0.047). ASI and LVMI were significantly higher, and aortic strain significantly lower, in the PE group. Among PE patients, those with MH had elevated ASI, LVMI, and isovolumic relaxation time. In multivariate analysis, ASI (OR = 6.12, p = 0.002) and LVMI (OR = 1.05, p = 0.048) independently predicted MH. Masked hypertension is common among women with a history of preeclampsia and is linked to increased vascular stiffness and cardiac remodeling. These findings support the integration of ABPM and echocardiographic evaluation into postpartum cardiovascular risk screening, especially in high-risk women.