A study looks at whether the adverse cardiac remodeling during a hypertensive pregnancy can be reversed with optimal blood pressure control in the postpartum period.
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This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital. I'd like to talk with you about a recent report in Circulation, the Go Red for Women issue, that suggests that the postpartum period may be a critical window of opportunity for improving cardiovascular health among women with a hypertensive pregnancy — those with preeclampsia or gestational hypertension during pregnancy.

Now, this is a small randomized trial from the UK, but it may have a very big clinical message, especially in terms of proof of principle. The trial is called POP-HT (Physician Optimized Postpartum Hypertension Treatment). About 200 women were randomized to improved blood pressure control or to usual care after a hypertensive pregnancy. The investigators had previously shown that the intervention did improve blood pressure control at 9 months. The purpose of this study was to look at whether the improved blood pressure control could reverse some of the adverse cardiac remodeling that takes place during a hypertensive pregnancy.

They did multimodality imaging, including transthoracic echocardiography as well as cardiac MRI. They did the imaging at the end of the pregnancy, at the time of delivery, and then again 9 months postpartum. They found that the women who were randomized to the intervention vs usual care had more favorable results in terms of cardiac structure and function. They had less wall thickness, lower left ventricular mass, lower end diastolic and end systolic volumes, as well as higher ejection fractions. Whether these results will translate into lower risk for heart failure (HFrEF, HFpEF) or lower risk for coronary heart disease or stroke events — and women with these hypertensive pregnancies are at higher risk for these adverse cardiovascular events — will need to be determined with larger trials and longer-term follow up.

However, the study suggests that the postpartum period is another critical window of opportunity for improving women's cardiovascular health. Previous studies have suggested that preconception and pregnancy are critical periods, as well as the menopause transition and early post-menopause. This study suggests that the postpartum period is also a very important timeframe for trying to optimize blood pressure control among women with hypertensive pregnancies.

Thank you so much for your attention. This is JoAnn Manson.

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