Cardiac Remodeling After Hypertensive Pregnancy Following Physician-Optimized Blood Pressure Self-Management: The POP-HT Randomized Clinical Trial Imaging Substudy
Authors' conclusion
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.
Study context
- Population
- Women ≥18 years with preeclampsia or gestational hypertension requiring antihypertensives on hospital discharge postnatally187 had echo at baseline and follow-up
- Participants
- 220 women
- Comparison
- Self-monitoring with physician-optimized antihypertensive titration vs usual postnatal care
- Primary endpoint
- Prespecified secondary cardiac imaging outcomes:
- Echocardiography
- CMR at follow-up
- Follow-up
- Around 9 months postpartum
Methodological detailsprospective, open-label, blinded end point, single UK hospital, imaging substudy
- Prospective
- Open-label
- Blinded end point
- Single UK hospital
- Imaging substudy
Primary result
As reported in the abstract
mean 258±14.6 days postpartum
Intervention vs Usual careDifference, g/m2 (95% CI)P value
LV mass by CMR
−6.37(−7.99 to −4.74)
P < 0.001Intervention vs Usual careDifference, mL/m2 (95% CI)P value
End-diastolic volume by CMR
−3.87(−6.77 to −0.98)
P = 0.009Intervention vs Usual careDifference, % (95% CI)P value
LVEF, higher with intervention
2.6(1.3–3.9)
P < 0.001RVEF, higher with intervention
2.8(1.4–4.1)
P < 0.001- Relative wall thickness by echocardiography, lower with intervention
- difference 0.06 (95% CI 0.07–0.05); P < 0.001
- End-systolic volume by CMR
- difference −3.25 mL/m² (95% CI 4.87 to −1.63); P < 0.001
- Average E/E' by echocardiography, mean difference 0.52 (95% CI, −0.97 to −0.07) between baseline and follow-up, adjusted for baseline differences
- P = 0.024
- Left atrial volumes by echocardiography, reduction of −4.33 mL/m² (95% CI, −5.52 to −3.21) between baseline and follow-up, adjusted for baseline differences
- P < 0.001
Original publication
Cardiac Remodeling After Hypertensive Pregnancy Following Physician-Optimized Blood Pressure Self-Management: The POP-HT Randomized Clinical Trial Imaging Substudy. Circulation. Published 11 November 2023. doi:10.
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