Postpartum blood pressure monitoring across hypertensive disorders of pregnancy.

BACKGROUND: Hypertensive disorders of pregnancy (HDP) are a leading cause of postpartum morbidity and readmission, yet patterns of monitoring fidelity and persistent hypertension are incompletely characterized. We evaluated postpartum blood pressure (BP) trajectories, monitoring fidelity, and predictors of persistent hypertension and readmission in a large remote BP cohort. STUDY DESIGN: We conducted a retrospective analysis of 5940 postpartum individuals with HDP enrolled in a standardized 14-day text-based remote BP monitoring program from 2020 to 2025. BP patterns and monitoring fidelity was descriptively analyzed. Multivariable logistic regression identified predictors of persistent hypertension and 6-week readmission; linear probability models evaluated associations between early postpartum BP and persistent hypertension. MAIN OUTCOME MEASURES: Persistent hypertension was defined as systolic BP ≥130 mmHg and/or diastolic BP ≥80 mmHg at the end of monitoring. RESULTS: Among 4531 participants with end-of-monitoring BP data, 67.3% met criteria for persistent hypertension (≥130/80 mmHg). Median consecutive monitoring days were 8; only 31.3% completed all 14 days. Black race (adjusted odds ratio [aOR] 1.91, 95% CI 1.62-2.26) and preeclampsia with severe features (aOR 1.72, 95% CI 1.56-1.92) were associated with persistent hypertension and readmission. Early diastolic BP strongly predicted persistent hypertension. CONCLUSIONS: Hypertension is common following HDP. Although 87% of participants submitted at least one BP after the first week, participation declined substantially thereafter, potentially limiting detection of ongoing risk. Early diastolic BP, Black race, and preeclampsia with severe features were associated with persistent hypertension after rBPM. Extended BP surveillance, coupled with strategies to sustain monitoring engagement may be warranted.