Pre-pregnancy hypertension in both rural and urban settings has nearly doubled over the past decade, and disparities persist, according to research published Nov. 9 in the Journal of the American College of Cardiology and being presented at AHA 2020.

Natalie A. Cameron, MD, et al., looked at the Centers for Disease Control and Prevention Natality data on all live births in women ages 15 to 44 years old from 2007 to 2018. Rates of pre-pregnancy hypertension were calculated per 1,000 live births overall and by urbanization status.

Results showed that among 47,949,381 live births, rates of pre-pregnancy hypertension per 1,000 live births increased among women in both rural settings (13.7 to 23.7) and urban settings (10.5 to 20.0).

In addition, the authors found that increases in rates of hypertension accelerated from 2016 to 2018, with "estimated annual relative increase as high as 15% on average per year in 20- to 24-year-old women in rural areas."

According to the authors, "although the overall rural-urban gap has slightly narrowed, significant disparities persist across the reproductive life course, with an approximately relatively 20% higher pre-pregnancy hypertension rate among women residing in rural compared with urban areas with similar patterns across all age and race/ethnicity subgroups."

In a related editorial comment, Garima Sharma, MD, FACC, et al., explain that moving forward, "we have to improve research, education, the quality of our preventive and obstetrical programs, and policy capacities to support maternal health equity. To reduce our maternal mortality rate, we have to call upon stakeholder partnerships to work together and divert health care expenditure toward preventive health in all young women."

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Prevention, Vascular Medicine, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Hypertension

Keywords: AHA Annual Scientific Sessions, AHA20, Pregnancy, Adolescent, Maternal Mortality, Live Birth, Urbanization, Ethnic Groups, Health Expenditures, Pregnancy Rate, Birth Rate, Prehypertension, Rural Population, Centers for Disease Control and Prevention, U.S., Preventive Health Services, Hypertension

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