Prospective Longitudinal Assessment of Central Hemodynamic Profile in Normotensive, Hypertensive and Preeclamptic Women in Pregnancy and Postpartum

Background/Objectives: Central hemodynamic assessment may provide information complementary to brachial blood pressure in hypertensive disorders of pregnancy, but its clinical predictive value remains uncertain. This prospective longitudinal study evaluated central aortic systolic blood pressure (AoSBP), augmentation index (AIx), augmentation index normalized to 75 beats/min (AIxHR75), pulse pressure amplification (PPAmpl), and carotid–femoral pulse wave velocity (cfPWV) in pregnant women followed at a tertiary outpatient clinic in Poznan, Poland. Methods: Between 2017 and 2023, 241 consecutive pregnant women were examined during pregnancy and postpartum using applanation tonometry (SphygmoCor® PVx). The cohort included 40 normotensive controls, 152 women with hypertension without preeclampsia (HT), and 49 women with hypertension complicated by preeclampsia (HT + PE). Longitudinal profiles were analyzed using prespecified gestational periods, and additional mixed-effects and exploratory ROC analyses were performed in the subgroup with complete observations from 19–22 to 31–34 weeks of gestation. Results: AoSBP was consistently lower in controls than in hypertensive women despite pharmacological control of brachial blood pressure in the hypertensive groups. In the complete-case analysis, AoSBP differentiated the groups most clearly: it was higher in HT than in controls from 19–22 to 31–34 weeks and increased further in HT + PE from 23–26 weeks onward. PPAmpl showed no significant group, period, or interaction effect, whereas AIx and AIxHR75 changed over time but did not show robust between-group differences after Holm correction. Exploratory ROC analyses showed only moderate discrimination for selected parameters and should be considered hypothesis-generating. Conclusions: Women who developed preeclampsia showed an altered central hemodynamic phenotype compared with normotensive pregnancies and uncomplicated hypertensive pregnancies. These findings indicate association and discrimination at the group level, not clinically validated early prediction. External validation and multivariable models including conventional clinical variables and blood pressure measures are required before clinical implementation.