(893) Predicting Persistent Postpartum Hypertension after Hypertensive Disorders of Pregnancy: A Meta-Analysis of Prevalence and Predictors

While hypertensive disorders of pregnancy (HDP) are known to increase long-term cardiovascular risk, predicting which women will develop persistent postpartum hypertension (PPPH) remains a clinical challenge. This study aimed to determine the pooled prevalence of PPPH after HDP and to evaluate key maternal predictors.

Study Design:

A systematic review and meta-analysis was conducted by searching Embase, PubMed, Scopus, and grey literature in July 2025. PPPH was defined as the persistence of hypertension (blood pressure ≥ 140/90 mmHg) for at least 6 weeks after delivery in women previously diagnosed with a HDP, excluding those with pre-existing chronic hypertension and cases due to medication withdrawal. Random-effects models were used to pool the prevalence overall, as well as for early (6 weeks to 3 months) and late (4 to 12 months) follow-up periods. Standardized mean differences (SMD) were synthesized for continuous predictors.

Results:

Ten studies involving 5750 participants were included. The overall pooled prevalence of PPPH was 12.5% (95% CI, 11.7-13.4%; I² = 97.3%). Prevalence peaked at 24.4% (95% CI, 21.5-27.2%; I² = 92.7%) during the initial 6 weeks to 3 months postpartum, declining to 11.4% (95% CI, 10.6-12.3%; I² = 98.1%) by 4 to 12 months postpartum. In predictor analysis, women with PPPH were significantly older (SMD 0.34; 95% CI 0.06 - 0.62; I² = 91.2%) and had a higher pre-pregnancy BMI (SMD 0.57; 95% CI 0.35 - 0.80; I² = 83.8%). Gestational age at delivery did not differ significantly (p = 0.15).

Conclusion:

The finding that nearly 1 in 4 women with prior HDP remain hypertensive at three months postpartum challenges the adequacy of the traditional 6-week visit and confirms the high-risk period extends well beyond the conventional puerperium. Advanced maternal age and elevated pre-pregnancy BMI are powerful predictors that must guide the development of risk-stratified, extended surveillance and cardiometabolic counseling.