Winok Lapidaire, PhD on brain volumes following hypertensive pregnancies

A randomized clinical trial published in JAMA Neurology suggests that physician-guided self-management of blood pressure during the early postpartum period after a hypertensive pregnancy may be associated with measurable differences in brain structure within the first year after delivery. The secondary analysis builds on the Physician Optimized Postpartum blood pressure self-management trial (POP-HT) and adds to growing evidence that hypertensive pregnancy has lasting neurologic as well as cardiovascular implications.

“We initially looked at the brain because we do know that there’s this link between hypertension in pregnancy and later life vascular dementia, and also, actually earlier in life, already some cognitive problems and higher rates of mental health issues,” said Winok Lapidaire, PhD, senior postdoctoral research associate in the Department of Medicine at the University of Oxford and a co-author of the study. “So we knew there’s something going on with the brain. But what we didn’t know is if that is a consequence of this sort of long-term deteriorated vascular decline in these women.”

The POP-HT trial enrolled women with preeclampsia or gestational hypertension who required antihypertensive medication at hospital discharge and randomized them to telemonitored self-management with research physician–guided titration or usual postnatal care. Brain magnetic resonance imaging was performed around 9 months postpartum in a subset of participants.

“To my surprise, actually, we did find that there is an effect,” Lapidaire said. “What we found is the intervention group had higher white matter volume. So white matter is basically the stuff that connects all of your brain cells. It’s sort of the superhighways of the brain, making information transfer much more efficient and quick.”

In addition to the overall white matter finding, Lapidaire described differences within the usual-care group based on hypertensive disorder subtype. “Those women who had preeclampsia, compared to those with gestational hypertension in the non-intervention group, the women with preeclampsia had lower subcortical volumes,” she said. “But this difference wasn’t there in the intervention group. So that suggests, really, that the intervention was very beneficial for the women who had preeclampsia, because they kind of got raised up to the level of those who had gestational hypertension.”

Lapidaire noted that these results reinforce the idea that the brain is dynamic and potentially modifiable during and after pregnancy. “It kind of shifts the thinking around the brain. It’s plastic, and it does actually change. We know that it changes throughout pregnancy. We actually know that the brain also remodels, as it were, just like the heart does after pregnancy.”

Although the intervention focused only on blood pressure control, the neurologic effects were still evident. “Nothing particularly focused on the brain, but even that was very beneficial for the women in the intervention group,” she said.

She emphasized that neurologic symptoms after hypertensive pregnancy may be overlooked. “Loss of concentration or difficulty just getting through the day and doing your daily tasks can be a symptom of something going on in your brain after hypertensive pregnancy,” Lapidaire said. “So for women, I would say just if you feel that way, do take it seriously, because it might very well be explainable, and it could therefore maybe be ameliorated by managing your blood pressure a little bit more closely.”

Looking ahead, Lapidaire stressed the importance of long-term vigilance. “Reducing risk of dementia is incredibly important,” she said. “The brain is very important, even though it might not be obviously and directly linked to the disease. It actually is impacted by hypertension and hypertension in pregnancy.”

Reference:

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. Published online January 05, 2026. Accessed January 30, 2026. doi:10.1001/jamaneurol.2025.5145