Impact of a Postpartum Hypertension Clinic on Cardiovascular Screening After Hypertensive Disorder of Pregnancy

BACKGROUND: Postpartum hypertension (HTN) clinics may improve cardiovascular (CV) prevention care for individuals with hypertensive disorders of pregnancy (HDPs) at an increased risk of CV disease. OBJECTIVES: This study compares rates of CV screening and engagement in postpartum care between postpartum HTN clinic attendees and nonattendees. METHODS: We compiled a retrospective cohort of patients with HDP who participated in remote blood pressure (BP) monitoring and remained hypertensive at 6 weeks postpartum. Our exposure was attending a postpartum HTN clinic within 1 year of delivery. We compared outcomes (1-year completion rates of outpatient BP ascertainment, lipid screening, hemoglobin A1c [HbA1c], and primary care physician [PCP] follow-up) using multivariate logistic regression adjusting for relevant demographic and clinical covariates. RESULTS: Among 2,816 patients with HDP and persistent hypertension at 6 weeks postpartum, 7.6% (n = 213) had a clinic visit. Clinic attendees were more likely to be self-identified Black race (31.0% vs 20.9%; P = 0.004) and have chronic HTN (20.1% vs 13.3%; P = 0.008) or superimposed preeclampsia (5.5% vs 2.2%; P = 0.003). In adjusted analyses, for every 100 patients seen in clinic, there were 10.7 more BPs recorded (95% CI: 4.1-17.3), 26.8 more lipid panels (20.3-33.3), 22.5 more HbA1c screenings (16.4-28.7), and 10.8 more PCP follow-ups (3.9-17.6) for clinic attendees compared with non-attendees. CONCLUSIONS: Attendees at a postpartum HTN clinic had higher rates of CV risk factor screening, including lipid, HbA1c, and BP ascertainment, and PCP follow-up. These results demonstrate the importance of increasing access to postpartum HTN clinics to manage CV risk after HDP.