Rate of hypertension during pregnancy doubled since 2008
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Key takeaways:
- The rate of chronic hypertension during pregnancy doubled in the U.S. since 2008.
- Antihypertensive use was unchanged despite updated guidelines on clinical BP management issued in 2017.
The prevalence of chronic hypertension during pregnancy doubled in the U.S. since 2008, with no changes in antihypertensive use over the years despite updated clinical guidance on BP control, researchers reported.
“We had hoped to see some impact from the 2017 guideline, which reduced the blood pressure threshold for treatment of hypertension. We were surprised to not find any meaningful changes from before and after the guideline,” Stephanie A. Leonard, PhD, epidemiologist and assistant professor in maternal-fetal medicine and obstetrics at Stanford University School of Medicine, said in a press release. “While the rate of hypertension in pregnancy has doubled, the use of medication for treatment remained stable at only 60%, which we believe is likely below what it should be if patients are treated according to clinical guidelines.”
In 2017, the updated guideline on the prevention, detection, evaluation and management of hypertension was published with lower thresholds of diagnosis, with stage 1 hypertension redefined as systolic BP of 130 mm Hg to 139 mm Hg and diastolic BP of 80 mm Hg to 99 mm Hg.
The updated guideline was backed by the American College of Cardiology, American Heart Association, American Academy of Physician Assistants, Association of Black Cardiologists, American College of Preventive Medicine, American Geriatrics Society, American Pharmacists Association, American Society of Hypertension, American Society for Preventive Cardiology, National Medical Association and Preventive Cardiovascular Nurses Association, and published in Hypertension.
To better understand trends in the prevalence and treatment of hypertension during pregnancy, Leonard and colleagues analyzed insurance claims data gathered from 2008 to 2021 from a large commercial database (Merative, MarketScan). Their study was also published in Hypertension.
Data from more than 1.9 million U.S. pregnancies were evaluated.
During the study period, the prevalence of chronic hypertension during pregnancy increased from 1.8% to 3.7%, overall. However, the proportion of pregnant individuals with chronic hypertension using antihypertensive medication remained relatively unchanged, at 57% to 60%.
Chronic hypertension during pregnancy was more prevalent among individuals aged 35 years or older, living in the South or with comorbidities.
Use of various antihypertensive drugs during pregnancy varied from 2008 to 2021:
- methyldopa use decreased from 29% to 2%;
- hydrochlorothiazide use decreased from 11% to 5%;
- labetalol use increased from 19% to 42%; and
- nifedipine use increased from 9% to 17%.
“This study highlights the growing burden of chronic hypertension and poor cardiovascular health prepregnancy as critical targets to improve maternal health. These data are consistent with prior studies highlighting the increasing prevalence of hypertension from data from the National Vital Statistics System, which covers all births in the U.S.,” Sadiya S. Khan, MD, MSc, FAHA, Magerstadt Professor of Cardiovascular Epidemiology and associate professor of medicine and preventive medicine at the Northwestern University Feinberg School of Medicine, a preventive cardiologist at Northwestern Medicine, and chair of the writing group that wrote the 2023 AHA scientific statement on CV health during pregnancy and postpartum, who is not an author of the present study, said in the release. “Since nearly one in three individuals with chronic hypertension may face a pregnancy complication, the prevention and control of hypertension should be among the highest priorities for improving maternal health.”
References:
- Chronic high blood pressure during pregnancy doubled between 2008 and 2021 in the U.S. https://newsroom.heart.org/news/chronic-high-blood-pressure-during-pregnancy-doubled-between-2008-and-2021-in-the-u-s. Published June 17, 2024. Accessed June 26, 2024.
- Whelton PK, et al. Hypertension. 2017;doi:10.1161/HYP.0000000000000065.
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