Postpartum Blood Pressure After Hypertensive Disorders of Pregnancy and Subsequent Cardiovascular Disease: A Population‐Based Cohort Study

OBJECTIVE: To assess the association between blood pressure values at 6 weeks postpartum and subsequent cardiovascular disease (CVD) over a 20-year period among women with hypertensive disorders of pregnancy (HDP). DESIGN: Population-based cohort study. SETTING: English primary and secondary care data, linked to cause-specific mortality records from 2000 to 2020. POPULATION: A cohort of 39 934 women between 15 and 49 years of age at birth who had HDP, were registered with a general practitioner (GP) contributing to the Clinical Practice Research Datalink (CPRD), and eligible for linkage to hospital episode statistics (HES) data were included. We excluded 22 100 (55.3%) women with no blood pressure values recorded at 6 weeks postpartum. METHODS: Primary analysis included multivariable Cox regression modelling (weighted by the inverse probability of having a severe HDP). MAIN OUTCOME MEASURE: Validated composite outcome of 12 cardiovascular diseases. RESULTS: The rate for incident cardiovascular events was 109 per 10 000 person-years; 794 (68%) of them occurred in women aged < 40 years. Women with abnormal blood pressure at 6 weeks postpartum had a higher risk of subsequent CVD than women with normal blood pressure: 10.9% vs. 5.4% - adjusted hazard ratio 1.96 (95% CI 1.51-2.54). CONCLUSIONS: Less than half of women with HDP had a blood pressure record in their GP notes at 6 weeks postpartum. The absence of a record of normal blood pressure at this time point was associated with an increased risk for subsequent CVD The immediate postpartum period may be a crucial window in preventive care to improve women's health.