Postpartum BP control tied to brain volume after hypertension

Brain volume is increased during the first year postpartum in patients receiving short-term postpartum optimization of blood pressure control following hypertensive pregnancy, according to a recent study published in JAMA Neurology.¹

Up to 15% of pregnancies are impacted by hypertensive disorders of pregnancy (HDPs), with more severe cases having multiorgan systemic organ involvement. These conditions have been linked to neurological conditions such as stroke, cerebral small vessel disease, and dementia, possibly linked to lower brain volumes during and after pregnancy among these patients.²

“These observations suggest that enhancing postpartum recovery could help preserve long-term brain health, yet whether postpartum interventions can modify brain volumes remains unknown,” wrote investigators.¹

Intervention and usual care comparison

The randomized, open, blinded end-point study was conducted to evaluate brain volume recovery in patients receiving antihypertensive medication in the weeks following delivery. Women aged at least 18 years diagnosed with gestational hypertension or preeclampsia during pregnancy by a clinician were eligible for inclusion.

Patients with chronic hypertension, prepregnancy antihypertensive use, or hypertension at a routing antenatal 12-week check were excluded. Participants self-reported their race and ethnicity based on National Institute for Health Research categories.

A Bluetooth-enabled blood pressure monitor (EVOLV; Omron) allowed patients receiving the intervention to provide daily home blood pressure measurements. The National Health Service clinical team prescribed initial discharge medications.

In comparison, controls underwent usual care, which, included community midwife blood pressure at 3 to 5 days and 7 to 14 days postpartum, alongside a review with a family physician or specialist at 6 to 8 weeks postpartum. Patients were randomized 1:1 to receive either the intervention or usual care.

Participant characteristics and follow-up

Of the 4 primary study visits, relevant data was obtained at baseline and the final visit at approximately 9 months postpartum. This data included medical history, demographics, blood pressure measurements, and brain magnetic resonance imaging (MRI) data.

Differences in total gray matter, white matter, and cerebrospinal fluid volumes were reported as the primary outcome. Investigators also further analyzed volumes of subcortical structures linked to hypertension.

There were 220 participants enrolled in the trial, 112 of whom were randomized to the intervention group and 108 to the usual care group. The final study visit was completed by 92% of these patients, and 71% received MRI. Sixty-nine percent of patients, 81 in the intervention group and 71 in the usual care group, were included in the final analysis.

Similar rates of preeclampsia and gestational hypertension were reported across both groups, with prevalences of 63% and 37%, respectively. Additionally, demographic data did not significantly differ between groups, though prior hypertensive pregnancy was more often reported in the intervention vs control group.

White matter volume findings

A significant increase in white matter volumes was reported in the intervention vs control group, with an adjusted mean difference of 11.50 cm³. However, gray matter, cerebrospinal fluid, and individual subcortical volumes were not significantly impacted by the intervention.

Adjusting for baseline mean diastolic blood pressure did not significantly impact this association, with a gray matter adjusted mean difference of 3 cm³, a white matter adjusted mean difference of 11 cm², and a cerebrospinal fluid adjusted mean difference of -6 cm³. Overall, this data highlighted benefits in multiple organs from improved postpartum blood pressure control.

“A postpartum intervention in the puerperium may benefit brain remodeling during a critical phase in women who have had hypertensive disorders of pregnancy,” wrote investigators.

References

1. Lapidaire W, Kitt J, Krasner S, et al. Brain volumes after hypertensive pregnancy and postpartum blood pressure management: A POP-HT randomized clinical trial imaging substudy. JAMA Neurol. 2026. doi:10.1001/jamaneurol.2025.5145
2. Oatridge A, Holdcroft A, Saeed N, et al. Change in brain size during and after pregnancy: study in healthy women and women with preeclampsia.AJNR Am J Neuroradiol. 2002;23(1):19-26.