High risk of hypertension after pregnancy

3 minute read

An international study has highlighted the importance of screening for high blood pressure in pregnant women.

Pregnant women who develop blood pressure-related conditions like pre-eclampsia and gestational hypertension are more than twice as likely to develop hypertension in the decade after their pregnancy, international research has found. 

A study published in the?Journal of the American College of Cardiology found a 2.4 higher risk of hypertension post-pregnancy in women with a history of hypertensive disorders of pregnancy (HDP). The study, which assessed 135 women post-pregnancy, also found that more than half of them – regardless of HDP history – met the criteria for at least stage I hypertension but had not received a formal diagnosis.  

Lead author Dr Lisa Levine, director of the Pregnancy and Heart Disease Program at Hospital of the University of Pennsylvania, said this highlighted the importance of screening for hypertension in all pregnant women. 

“[Our trial] along with studies with similar findings, further highlights the importance of routine screening for hypertension in this population,” she said.  

“Future studies should evaluate the optimal time period to screen for postpartum hypertension and a monitoring plan for these at-risk women.” 

HDP affects close to 20% of all pregnancies and is the leading cause of maternal death around the world. Research has shown that patients with a history of HDP have higher long-term risks of heart disease and stroke, with most events developing 20-30 years after pregnancy.  

In the five to 10 years post-HDP, many patients may be asymptomatic and not seeking care; however, they are still at increased CV risk and may benefit from preventative care, the researchers wrote. 

The study assessed 135 patients, 84 of them with a history of HDP. 

As part of the study, all participants underwent in-person visits with echocardiography, arterial tonometry and flow mediated dilation of the brachial artery. 

While they found patients with a history of HDP had greater risk of new hypertension compared to those who did not have HDP (56% vs 23.5%), there was no association with other CV risk factors like diabetes or obesity, nor were there differences in non-invasive subclinical measures of CV risk, including measures of left ventricular structure, global longitudinal strain or endothelial function. 

Researchers said differences in subclinical measures were mostly driven by whether the patient had a hypertension diagnosis, regardless of HDP history, which suggests that hypertension itself explains a large portion of future CV risk for women with a history of HDP. 

While an increased risk of hypertension after HDP is not a new finding, the researchers said this was the most comprehensive study to date of cardiac risk factors and cardiovascular disease in patients with a prior history of HDP. Other studies have been limited by small cohort sizes, a lack of racial diversity and a limited assessment of broad CV phenotyping. 

Further, they found that more than 80% of patients in the study with prior HDP and 60% without a history of HDP had either stage I or stage II hypertension. Of those patients, only 39% with prior HDP had been formally diagnosed before being screened as part of the study. 

In an accompanying editorial comment, Dr Josephine Chou, director of cardio-obstetrics and co-director of maternal cardiology at Yale University School of Medicine, said this contributed to a better understanding of HDP and hypertension within the first decade after pregnancy. 

“[This study] paves the way for future efforts to improve postpartum CV care, enabling us to grasp this opportunity of a lifetime to ultimately reduce maternal and pregnancy-related morbidity and mortality,” she said. 

Journal of the American College of Cardiology 2022, online 21 June 

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