Preeclampsia, hypertension during pregnancy more than doubles long-term hypertension risk
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A cohort of mostly Black women who developed a hypertensive disorder of pregnancy were 2.4 times more likely to develop hypertension 10 years later, data from a prospective study show.
In an analysis of women who participated in an earlier study that enrolled women with confirmed preeclampsia or gestational hypertension and normotensive controls, researchers also found that differences in noninvasive measures of CV risk were driven mostly by the hypertension diagnosis, regardless of history of a hypertensive disorder of pregnancy.
“There was an incredibly high prevalence of undiagnosed hypertension where patients would not have known they had chronic hypertension if they had not been enrolled in this study,” Lisa D. Levine, MD, MSCE, the Michael T. Mennuti, MD, Associate Professor in Reproductive Health, division chief of maternal fetal medicine in the department of obstetrics and gynecology and director of the pregnancy and heart disease program at the University of Pennsylvania Perelman School of Medicine, told Healio. “Importantly, patients with a history of preeclampsia or any hypertensive disorder of pregnancy were almost 2.5 times more likely to develop chronic hypertension. The most significant point is that it appears the development of chronic hypertension itself is the driving factor in the development of future heart disease among these patients with a history of hypertensive disorders of pregnancy.”
As Healio previously reported, prior research indicates hypertension develops faster among women who experienced hypertensive disorders of pregnancy, up to 10 years earlier, compared with women with normotensive pregnancies.
Assessing hypertension during pregnancy
In a prospective, cross-sectional study, Levine and colleagues analyzed data from 84 patients with and 51 patients without a history of a hypertensive disorder of pregnancy randomly selected from an earlier study who participated in a follow-up study.
“For the current study, only patients without a history of cardiac disease, chronic hypertension or pregestational diabetes at the time of enrollment into the original parent study (10 years earlier) were included,” the researchers wrote. “However, patients that developed hypertension, diabetes or cardiac disease since the time of enrollment into the original study were included, because they were considered outcomes.”
Participants underwent in-person visits with echocardiography, arterial tonometry and flow-mediated dilation of the brachial artery. The mean baseline age was 39 years for women with no history of a hypertensive disorder of pregnancy and 36 years for those with a hypertensive history; 85% of patients were Black. Hypertensive disorders of pregnancy were defined as gestational hypertension as well as preeclampsia and superimposed preeclampsia, with or without severe features.
The findings were published in the Journal of the American College of Cardiology.
Researchers found that patients with a history of a hypertensive disorder of pregnancy had a 2.4-fold increased risk for new hypertension compared with those without a hypertensive disorder of pregnancy (adjusted RR = 2.4; 95% CI, 1.39-4.14) with no differences in measures of left ventricular structure, global longitudinal strain, diastolic function, arterial stiffness or endothelial function.
Regardless of having a history of a hypertensive disorder of pregnancy, those who developed hypertension had greater LV remodeling, including greater relative wall thickness, as well as worse diastolic function, including lower septal and lateral e’ and E/A ratio. Those who developed hypertension also showed more abnormal longitudinal strain and higher effective arterial elastance compared with patients without hypertension.
“These data highlight the importance of screening patients for the development of hypertension and ensuring patients and providers are aware of this risk,” Levine told Healio. “Future studies should focus on ways to ensure patients and providers know the overall risk for hypertension after hypertensive disorders of pregnancy, determine best screening practices (how frequently to screen, screen with home BP, in-office, etc) and then evaluate whether earlier diagnosis, screening and treatment can prevent future CVD associated with hypertensive disorders of pregnancy.”
‘Multipronged solutions’ needed
In a related editorial, Josephine C. Chou, MD, MS, of the section of cardiovascular medicine at Yale University School of Medicine, wrote that Black patients are disproportionately affected by hypertensive disorders of pregnancy and their complications; however, it is important to recognize race as a social construct and not an inherent risk factor for disease.
“There is additional hypertensive disorders of pregnancy heterogeneity among Black patients because of differences in socioeconomic indexes (employment, income, education, social supports) as well as nativity and duration of U.S. residence,” Chou wrote. “Accumulated lifelong stress because of structural racism, residential segregation and persistent discrimination also negatively affects health, and contributes to hypertensive disorders of pregnancy and CVD. Thus, addressing disparate hypertensive disorders of pregnancy and CV outcomes require multipronged solutions targeting medical and societal inequities, in addition to psychological and community factors.”
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For more information:
Lisa D. Levine, MD, MSCE, can be reached at lisa.levine@pennmedicine.upenn.edu; Twitter: @lisaobdoc.
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