#1002 Spanish plan for hypertensive disorders in the puerperium: zero vascular and renal risk

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Abstract Background and Aims Hypertensive disorders of pregnancy (HDP) are associated with increased postpartum risk of cardiovascular disease (CVD) or kidney failure. Given the change in the profile of the current pregnant woman (older age at pregnancy, obesity, diabetes, use of assisted reproductive technologies, chronic hypertension and CKD) an increase in the incidence of HDP is being observed; according to the WHO 2%–10%. However, there is scarce information on current practice regarding follow-up of HDP in diverse healthcare systems in an evolving demographic environment. Spain is one of the western European countries without yet having a national HDP registry. An interdisciplinary Spanish group carries out by Nephrology, Primary Care; Obstetric proposed the need for a vascular and renal protection plan in the postpartum period focus on prevention, health promotion and monitoring in our healthcare system with universal free access. Aims: Analyze for the first time the incidence, development of HDP in Spain between 2016––2022 and its differences between different regions of Spain. Method Data was provided by the Registry of Specialized Care Activity of the Spanish Ministry of Health. HDP events were identified using ninth international classification of disease (ICD) codes from 2016 to 2023: pre-existing hypertension complicating pregnancy, childbirth and the puerperium [010], chronic hypertension with superimposed preeclampsia [O11], gestational [pregnancy-induced] oedema and proteinuria without hypertension [012], gestational hypertension [O13]. Incidence was analyzed with the number of cases divided by the number of births and multiplying by 100. Incidents were compared with the initial year (2016) to assess the evolution. These comparisons were made by calculating the incidence ratio or relative risk (RR), and its 95% confidence interval. Statistically significant was consider when the confidence interval not contain 1. The incidence between 2016 and 2022 was initially analyzed overall in Spain and subsequently was done individually among the different Spanish regions. Poisson regression models were perform to analyze the temporal evolution of different regions of Spain. Statistical significance of this interaction term was assessed using the likelihood ratio test. Additionally, p values ​​were corrected for multiple comparisons by the Benjamini-Hochberg method. If p of the interaction was less than 0.05, means that the temporal evolution was different in the two regions compared. Results A significant increased of HDP incidence was observed in 2021 [(1.80 vs 1.84; RR 1.055 (1.033–1.076)] and 2022 [(1.80 vs 1.90; RR 1.063 (1.041–1.084)] compared to 2016; table 1. The Spanish regions with higher incidence rate between 2016–2022 were : Balearic Islands, Canary Islands, Melilla, Aragón, Catalonia and Ceuta, Fig. 1. There was a significant difference in variability between the incidences of the different Spanish regions between the years 2016–2022; Table 2. Conclusion This is the first study to analyze the incidence of HDP in Spain and its different regions. A significant incidence increased over time from 2016 to 2022 was observed in Spain. Low overall incidence in Spain (1.8) compared to other European countries (France 2.3, Greece 2.2, Norway 4.0). Most regions in Spain present an incidence below 1, Fig. 1. The significant difference in incidences variability between the different regions in Spain points out the need for a homogeneous follow-up discharge - hospitalization protocol for Primary Care. The low incidence indicates an under diagnosis with a possible loss of follow-up of patients with the possible loss of follow-up of women with HDP and the cardiovascular risk that it entails.

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