AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Ambulatory Blood Pressure Monitoring at 12 Months Postpartum in Patients with Hypertensive Disorders of Pregnancy
By Knutson Sinaise M, Ryser S, Hetzel S et al.
Background: Ambulatory Blood Pressure Monitoring (ABPM) is the gold standard for accurately diagnosing hypertension (HTN) and related hypertensive phenotypes. Patients with hypertensive disorders of pregnancy (HDP) have a 4-fold increased risk of developing chronic HTN in the first year postpartum; however, HTN phenotypes remain poorly characterized. The objective of this study was to characterize HTN phenotypes with ABPM in patients who had gestational HTN or preeclampsia at 12-months postpartum. Methods: A planned secondary analysis of participants with gestational HTN or preeclampsia who participated in a single-site RCT (NCT05685251) that included 140 participants allocated 1:1 to standard care or self-measured blood pressure (SMBP) and health coaching, biweekly for 4 months, then monthly through 12 months. Eligible participants were offered one 24-hour ABPM testing at 12-months postpartum. Summary statistics were performed on baseline data and HTN phenotypes. Chi-squared and ANCOVA tests were used for comparative analyses (α=0.05). Results: ABPM testing was completed on 21/140 (15%) participants. One participant was excluded due to insufficient BP measurements. No participants were taking antihypertensives at the time of testing. Baseline diagnoses included gestational HTN (n=9), preeclampsia with severe features (n=8), and preeclampsia without severe features (n=3). At 12-months postpartum, daytime HTN was identified in 9/20 (45%), of which 6/9 (67%) had isolated diastolic hypertension (DBP ≥80mmHg). White Coat HTN was identified in 7/20 (35%) of participants (in clinic readings ≥130/80 and ABPM readings <130/80), nocturnal HTN (>110 and/or >65) in 9/18 (50%) and masked HTN (<130/80 in clinic and ≥130/80 ABPM) 1/20 (5%) was identified. The remaining had elevated (n=4; SBP 120-129) and normotensive (n=7; <120/80) BP. There were no observed differences in HTN phenotype by type of HDP or timing of HDP diagnosis (Table 2 & 3). Conclusions: At 12-months postpartum, ABPM in this cohort revealed high rates of daytime, isolated diastolic, and white coat hypertension. Patients with HDP should be made aware of their risk of developing chronic HTN, and furthermore, their HTN phenotype. Although ABPM may not be widely accessible, SMBP is recognized as an alternative to assess the presence of daytime, white coat and masked HTN. Accurate blood pressure surveillance and targeted risk assessment are essential to inform prognosis, counseling, and treatment strategies in future pregnancies and for long-term cardiovascular preventive management.