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Severe preeclampsia increases risk for hypertension in women
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Women who had severe preeclampsia during pregnancy had an increased risk for hypertension 1 year after delivery, according to a study published in Hypertension.
“Our findings suggest women who have high blood pressure during pregnancy should continue to monitor their blood pressure long after they’ve delivered their babies,” Laura Benschop, MD, a researcher in obstetrics and gynecology at Erasmus Medical Center in Rotterdam, the Netherlands, said in a press release.
Researchers analyzed data from 200 women (mean maternal age, 32 years) who had severe preeclampsia. Medical files and midwifery charts were reviewed for maternal characteristics. Patients completed a questionnaire at 3 months and 1 year after delivery to collect information on education, ethnicity, previous diagnosis of hypertension, pre-existing hypertension, breast-feeding, smoking, medication prescription and intervening pregnancies.
Office BP and 24-hour ambulatory BP monitoring were performed 1 year after delivery.
Some form of hypertension was seen in 41.5% of the cohort, including masked hypertension (17.5%), sustained hypertension (14.5%) and white-coat hypertension (9.5%). Only 24% of women would have been diagnosed with hypertension by office BP monitoring.
A disadvantageous dipping pattern was observed in 45.6% of women with normotensive daytime ambulatory BP monitoring and in 45.3% of women with hypertensive daytime ambulatory BP monitoring.
BMI and pre-existing hypertension were linked to hypertension after pregnancy. Pre-existing hypertension was also linked to an increased risk for office hypertension (OR = 3.1; 95% CI, 1-9.3), daytime hypertension with ambulatory BP monitoring (OR = 2.8; 95% CI, 1-7.7) and sustained hypertension (OR = 7.5; 95% CI, 1.7-32).
“Current clinical guidelines on the prevention of CVD and stroke after a hypertensive pregnancy disorder lack advice on [ambulatory BP monitoring] after delivery,” Benschop and colleagues wrote. “We think that [ambulatory BP monitoring] should be offered to all women who experienced severe preeclampsia for more accurate BP assessment. By doing so, hypertension management can be improved, which eventually might reduce the risk of future CVD.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Margo B. Minissian, PhD, ACNP, CLS, AACC, FAHA
What’s so important about studies such as these is that they bring light to the adverse pregnancy outcome story; in particular, for these high-risk severe preeclamptics. They have a seven- to eightfold increased risk for heart disease later in life. If one of three women are going to develop heart disease by the age of 60, it’s generally going to be this woman.
Accurate and timely capturing of essential hypertension, white-coat hypertension and impaired nocturnal BP dipping will be crucial. If we can identify these forms of hypertension early and treat appropriately, we could potentially ward off their heart disease altogether.
The findings are important. They talk about what was otherwise considered a low-risk group of women according to our culture. What we’re starting to learn is that, No. 1, these women continue to have hypertensive disorders way after their delivery, and No. 2, we are capable of capturing impaired BP with ambulatory BP monitoring.
It really is a callout to OB-GYNs, primary care doctors, cardiologists and all who care for younger, childbearing women that although her BP could potentially be normal in their office, they have a 41% chance of not being normal outside the office.
I would love to see more of a mechanistic understanding. We’re now describing the phenomena and we’re definitely contributing to that body of literature, but now we need to be able to hone in and target specific mechanistic pathways so that we can start to intervene in these women.
Current U.S. and European guidelines have identified these women as at-risk, but more needs to be done to bring to light the importance of the risk that these women carry so that the general provider can monitor them more closely.
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