HTN in Pregnancy More Than Doubles Risk of New HTN a Decade Later

The risk of developing hypertension is more than doubled a decade after a woman experiences gestational hypertension or preeclampsia, compared with women who do not experience any hypertensive disorders of pregnancy (HDP), according to a study published June 13 in the Journal of the American College of Cardiology.

Lisa D. Levine, MD, MSCE, Bonnie Ky, MD, MSCE, FACC, et al., conducted a prospective cross-sectional study to evaluate the prevalence of cardiovascular risk factors and cardiovascular disease among women with and without a history of HDP 10 years before. Patients were recruited from a completed prospective observational study conducted from 2005-2007 of women with HDP confirmed by an obstetrician. For the current study, conducted from April 2016 to December 2019, patients with a history of cardiac disease, chronic hypertension or pregestational hypertension at enrollment of the original study were excluded.

Echocardiography, arterial tonometry and flow-mediated dilation of the brachial artery were conducted in the 135 study patients (84 with HDP and 51 without HDP); 85% of participants self-identified as Black. There was a higher prevalence of Black patients with a history of HDP than those without (92% vs 78%; p=0.037).

Of note, 82.1% of the patients with prior HDP and 60% without HDP met criteria for either stage 1 or stage 2 chronic hypertension. Of these patients, only 39% with a history of HDP had been formally diagnosed before being screened for this study.

Results showed patients with a history of HDP had a 2.4-fold increased risk of new hypertension compared with those who did not have HDP (56.0% vs. 23.5%; adjusted relative risk, 2.4; 95% confidence interval [CI], 1.39-4.14); no differences were seen in left ventricular structure, global longitudinal strain or endothelial function.

There was no association with other cardiovascular risk factors such as diabetes or obesity, nor were there differences in noninvasive subclinical measures of cardiovascular risk, including measures of left ventricular structure, global longitudinal strain, diastolic function, arterial stiffness or endothelial function. However, among patients who developed hypertension, whether or not they had HDP, there were greater differences seen in left ventricular remodeling, worse diastolic function, more abnormal longitudinal strain and higher effective elastance.

Researchers said differences in subclinical measures were mostly driven by whether the patient had a hypertension diagnosis, regardless of HDP history, which suggests that hypertension itself explains a large portion of future CV risk for women with a history of HDP.

While an increased risk of hypertension after HDP is not a new finding, researchers said this is the most comprehensive study to date of cardiac risk factors and cardiovascular disease in patients with a history of HDP. Other studies have been limited by small cohort sizes, a lack of racial diversity and a limited assessment of broad cardiovascular phenotyping.

“The importance of studying a more diverse population, including a larger percentage of Black patients, is of critical importance given that both HDP and [cardiovascular disease] disproportionally affect Black women,” said Levine. She added, “[Our trial] along with studies with similar findings, further highlight the importance of routine screening for hypertension in this population. Future studies should evaluate the optimal time period to screen for postpartum hypertension and a monitoring plan for these at-risk women.”

In an accompanying editorial comment, Josephine Chou, MD, MS, writes, “[This study] paves the way for future efforts to improve postpartum [cardiovascular] care, enabling us to grasp this opportunity of a lifetime to ultimately reduce maternal and pregnancy-related morbidity and mortality.”

“Hypertension, known as a ‘silent killer,’ is sadly often underdiagnosed and undertreated, particularly among young adults” said Gina S. Wei, MD, MPH, associate director for Prevention and Population Science within the Division of Cardiovascular Sciences and senior advisor for Women’s Health at the National Heart, Lung, and Blood Institute. “This research further underscores the importance of detecting and treating hypertension early, especially among those who developed hypertension disorder of pregnancy.”

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Vascular Medicine, Hypertension

Keywords: Postpartum Period, Obesity, Diabetes Mellitus, Ventricular Remodeling, Vascular Stiffness, Manometry, Cardiology, Heart Disease Risk Factors, Dilatation, Confidence Intervals, Brachial Artery, Risk Factors, Prevalence, Cardiovascular Diseases, Cross-Sectional Studies, Pre-Eclampsia, Hypertension, Pregnancy-Induced, Pregnancy

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