Kitt, J;
Krasner, S;
Barr, L;
Frost, A;
Tucker, K;
Bateman, PA;
Suriano, K;
Kenworthy, Y;
Lapidaire, W;
Lacharie, M;
et al.
Kitt, J; Krasner, S; Barr, L; Frost, A; Tucker, K; Bateman, PA; Suriano, K; Kenworthy, Y; Lapidaire, W; Lacharie, M; Mills, R; Roman, C; Mackillop, L; Cairns, A; Aye, C; Ferreira, V; Piechnik, S; Lukaschuk, E; Thilaganathan, B; Chappell, LC; Lewandowski, AJ; McManus, RJ; Leeson, P
(2024)
Cardiac Remodeling After Hypertensive Pregnancy Following Physician-Optimized Blood Pressure Self-Management: The POP-HT Randomized Clinical Trial Imaging Substudy.
Circulation, 149 (7).
pp. 529-541.
ISSN 1524-4539
https://doi.org/10.1161/CIRCULATIONAHA.123.067597
SGUL Authors: Thilaganathan, Baskaran
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Abstract
BACKGROUND: Hypertensive pregnancy disorders are associated with adverse cardiac remodeling, which can fail to reverse in the postpartum period in some women. The Physician-Optimized Postpartum Hypertension Treatment trial demonstrated that improved blood pressure control while the cardiovascular system recovers postpartum associates with persistently reduced blood pressure. We now report the effect on cardiac remodeling. METHODS: In this prospective, randomized, open-label, blinded end point trial, in a single UK hospital, 220 women were randomly assigned 1:1 to self-monitoring with research physician-optimized antihypertensive titration or usual postnatal care from a primary care physician and midwife. Participants were 18 years of age or older, with preeclampsia or gestational hypertension, requiring antihypertensives on hospital discharge postnatally. Prespecified secondary cardiac imaging outcomes were recorded by echocardiography around delivery, and again at blood pressure primary outcome assessment, around 9 months postpartum, when cardiovascular magnetic resonance was also performed. RESULTS: A total of 187 women (101 intervention; 86 usual care) underwent echocardiography at baseline and follow-up, at a mean 258±14.6 days postpartum, of which 174 (93 intervention; 81 usual care) also had cardiovascular magnetic resonance at follow-up. Relative wall thickness by echocardiography was 0.06 (95% CI, 0.07-0.05; P<0.001) lower in the intervention group between baseline and follow-up, and cardiovascular magnetic resonance at follow-up demonstrated a lower left ventricular mass (-6.37 g/m2; 95% CI, -7.99 to -4.74; P<0.001), end-diastolic volume (-3.87 mL/m2; 95% CI, -6.77 to -0.98; P=0.009), and end-systolic volume (-3.25 mL/m2; 95% CI, 4.87 to -1.63; P<0.001) and higher left and right ventricular ejection fraction by 2.6% (95% CI, 1.3-3.9; P<0.001) and 2.8% (95% CI, 1.4-4.1; P<0.001), respectively. Echocardiography-assessed left ventricular diastolic function demonstrated a mean difference in average E/E' of 0.52 (95% CI, -0.97 to -0.07; P=0.024) and a reduction in left atrial volumes of -4.33 mL/m2 (95% CI, -5.52 to -3.21; P<0.001) between baseline and follow-up when adjusted for baseline differences in measures. CONCLUSIONS: Short-term postnatal optimization of blood pressure control after hypertensive pregnancy, through self-monitoring and physician-guided antihypertensive titration, associates with long-term changes in cardiovascular structure and function, in a pattern associated with more favorable cardiovascular outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04273854.
Item Type: | Article | ||||||||
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Additional Information: | © 2023 The Authors. Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited. | ||||||||
Keywords: | hypertension, pregnancy-induced, postpartum period, pre-eclampsia, self-management, ventricular remodeling, 1102 Cardiorespiratory Medicine and Haematology, 1103 Clinical Sciences, 1117 Public Health and Health Services, Cardiovascular System & Hematology | ||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) | ||||||||
Journal or Publication Title: | Circulation | ||||||||
ISSN: | 1524-4539 | ||||||||
Language: | eng | ||||||||
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Publisher License: | Creative Commons: Attribution 4.0 | ||||||||
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PubMed ID: | 37950907 | ||||||||
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URI: | https://openaccess.sgul.ac.uk/id/eprint/115880 | ||||||||
Publisher's version: | https://doi.org/10.1161/CIRCULATIONAHA.123.067597 |
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