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Hypertensive Disorders of Pregnancy and Chronic Hypertension Onset
Quick Takes
- Hypertensive disorders of pregnancy (HDP) are associated with early onset of chronic hypertension in young women.
- Women with severe or early-onset pre-eclampsia, or pre-eclampsia superimposed on gestational hypertension are at highest risk for developing chronic hypertension.
- Women with HDP would likely benefit from ongoing post-partum follow-up to improve screening and treatment of chronic hypertension.
Study Questions:
What is the impact of hypertensive disorders of pregnancy (HDP) on the onset of chronic hypertension in the first years following a woman’s first pregnancy?
Methods:
This study used the nationwide French National Health Data System and included primiparous women without pre-existing chronic hypertension who delivered between 2010–2018. The primary outcome was chronic hypertension. Women were followed from 6 weeks post-partum until onset of hypertension, a second pregnancy, death, or study end date (December 2018), whichever came first.
Results:
A total of 2,663,573 women were included; mean follow-up was 3.0 years; 180,063 (6.7%) had an HDP (2.2% pre-eclampsia, 4.3% gestational hypertension). Women with HDP (compared with women without HDP) had higher rates of subsequent chronic hypertension. Specifically, the fully adjusted hazard ratios of chronic hypertension were 6.0 (95% confidence interval [CI], 5.9–6.2) for gestational hypertension, 8.1 (95% CI, 7.88–8.33) for pre-eclampsia, 13.0 (95% CI, 12.3–13.6) for early pre-eclampsia (occurring before 34 weeks of gestation), 9.9 (95% CI, 9.5–10.3) for severe pre-eclampsia, and 13.2 (95% CI, 12.7–13.6) for women with pre-eclampsia superimposed on gestational hypertension.
Conclusions:
Women with HDP have increased risk of chronic hypertension in the first years after delivery. The risk is highest for women with early or severe pre-eclampsia, or pre-eclampsia following gestational hypertension. Increased efforts for screening and management are warranted.
Perspective:
A growing body of literature has demonstrated that HDP are associated with later development of chronic hypertension. This study also adds that the highest levels of risk occur when pre-eclampsia is severe, develops early in pregnancy, or is superimposed on gestational hypertension. Strengths of this study were the unique aspects of the study design: 1) only women with their first pregnancies were included, 2) follow-up ended if/when they had a second pregnancy, 3) overall short mean duration follow-up of 3 years, and 4) diagnosis of hypertension only with medication prescription. Prior studies have included multiple pregnancies and long duration of follow-up. The design of this study may have underestimated the incidence of hypertension in young women, yet still showed significant association between HDP and early onset of chronic hypertension. These findings provide powerful support for ongoing post-partum follow-up for women with HDP to ensure early diagnosis and treatment of chronic hypertension.
Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, Hypertension
Keywords: Blood Pressure, Eclampsia, Gravidity, Hypertension, Hypertension, Pregnancy-Induced, Pre-Eclampsia, Pregnancy, Primary Prevention, Prehypertension, Women
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