Impact of Blood Pressure Self-Management on Vascular Remodeling After Hypertensive Pregnancy

作者：Jamie Kitt, Luca Biasiolli, Samuel Krasner, Paul Bateman, Hannah Rebecca Cutler, Logan C. Barr, Annabelle Frost, Katherine L. Tucker, Katie Suriano, Yvonne Kenworthy, Winok Lapidaire, Miriam Lacharie, Rebecca Mills, Cristian Román, Lucy Mackillop, Christina Aye, Alexandra Cairns, B. Thilaganathan, Lucy C. Chappell, Adam J. Lewandowski, Richard J. McManus, Paul Leeson · 发表于：Hypertension · 年份：2025 · DOI：10.1161/hypertensionaha.125.24854 · 被引用次数：6 · 研究领域：Pregnancy and preeclampsia studies、Cardiovascular Issues in Pregnancy、Sodium Intake and Health

BACKGROUND: Hypertensive pregnancy disorders are associated with long-term adverse cardiac and vascular remodeling post index pregnancy. The POP-HT trial (Physician Optimised Postpartum Hypertension Treatment) demonstrated that improved puerperal blood pressure control leads to reduced blood pressure and beneficial cardiac remodeling during the first year postpartum. This study describes the impact on postpartum vascular remodeling. METHODS: A prospective, randomized, open-label, blinded end point trial in a single UK hospital where 220 women were assigned 1:1 to intervention (self-management via physician-guided antihypertensive titration) or control (usual postnatal care via primary care doctor±midwife). Eligible participants were ≥18 years, with preeclampsia or gestational hypertension and requiring antihypertensives on discharge. Prespecified secondary vascular outcomes included aortic blood pressure and pulse wave velocity measured by Vicorder at baseline and 9 months postpartum, and additional cardiovascular magnetic resonance measures of aortic distensibility were performed. RESULTS: There were no baseline differences in aortic blood pressure or pulse wave velocity but by 9 months postpartum, aortic diastolic blood pressure was −5.2 mm Hg lower ([95% CI, −8.0 to −2.2]; P <0.001), and pulse wave velocity was −0.71 m/s lower ([95% CI, −1.42 to −0.06]; P =0.048) in the intervention arm compared with the control arm, which corresponded with greater aortic distensibility...