Brain Volumes After Hypertensive Pregnancy and Postpartum Blood Pressure Management: A POP-HT Randomized Clinical...

Area of Science:

• Neurology
• Obstetrics
• Cardiology

Background:

• Hypertensive pregnancy disorders, such as preeclampsia, increase the long-term risk of cognitive decline, stroke, and dementia.
• Women with a history of hypertensive pregnancy exhibit reduced brain volumes, indicating potential long-term neurological impact.
• The effect of early postpartum blood pressure management on these neurological outcomes remains unclear.

Purpose of the Study:

• To assess if intensive postpartum blood pressure management after hypertensive pregnancy improves brain volumes around 9 months postpartum compared to standard care.
• To investigate the association between optimized postpartum blood pressure control and brain structural changes.

Main Methods:

• A prospective, open-label, blinded end-point randomized clinical trial (POP-HT) was conducted.
• Participants with preeclampsia or gestational hypertension were randomized to either telemonitored self-management with physician-guided titration or usual postnatal care.
• Brain volumes (gray matter, white matter, cerebrospinal fluid, subcortical structures) were analyzed using MRI at approximately 9 months postpartum.

Main Results:

• The intervention group showed significantly larger total white matter volumes compared to the usual care group (adjusted mean difference, 11.50 cm³; P = .02).
• In the usual care group, preeclampsia was associated with smaller putamen, accumbens, and pallidum volumes compared to gestational hypertension.
• These differences in subcortical volumes were not observed in the intervention group, suggesting a protective effect of optimized blood pressure control.

Conclusions:

• Short-term optimization of blood pressure postpartum following hypertensive pregnancy is linked to increased brain volumes within the first year.
• Brain volume serves as a surrogate marker for brain health, tissue preservation, and cognitive function.
• These findings suggest potential neurovascular benefits of optimized postpartum blood pressure management, especially for women with preeclampsia.