Six-week blood pressure after pre-eclampsia predicts heart disease, and is often never taken

Design

Population-based cohort, linked primary care, hospital and mortality records

Population

39,934 women with hypertensive disorders of pregnancy, England, 2000–2020

Primary outcome

Composite of 12 cardiovascular diseases over up to 20 years

Effect

10.9% vs 5.4%; adjusted HR 1.96 (1.51–2.54)

An English cohort linked primary care, hospital and death records for 39,934 women aged 15 to 49 who had a hypertensive disorder of pregnancy between 2000 and 2020. Only 17,834 (45%) had a blood pressure recorded at six weeks postpartum.

Cardiovascular events occurred at 109 per 10,000 person-years, and 68% of them were in women under 40. Those with an abnormal reading at six weeks had a higher risk of later cardiovascular disease than those with a normal one: 10.9% vs 5.4%, adjusted hazard ratio 1.96 (95% CI 1.51 to 2.54).

This is association, not proof that treating six-week blood pressure prevents events. But it makes the six-week reading a simple way to identify which women need closer follow-up, and shows how often the chance is missed.

In India, where postnatal follow-up often ends at discharge, the equivalent step is to measure and document blood pressure at the first postnatal contact and hand the result to whoever provides ongoing care.

• Measure blood pressure at six weeks in every woman who had a hypertensive pregnancy.
• Treat an abnormal reading as a marker for closer cardiovascular follow-up.
• Hand the reading and the diagnosis to the GP or physician who will see her next.
• Do not assume risk ended at delivery: most events here were before 40.

Why it matters

The check that best sorts women by future heart risk is one that more than half of them never had.

Don't overread it

This was observational — it shows who is at risk, not that treating the six-week reading prevents events.

The statistics, in plain English

An adjusted hazard ratio of 1.96 means women with an abnormal reading developed cardiovascular disease at about twice the rate of those with a normal one, after accounting for measured differences. The interval from 1.51 to 2.54 does not cross 1, so chance is an unlikely explanation. Over half the cohort had no reading and were excluded, so the women studied may differ from those never checked.

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