Hypertensive Disorders of Pregnancy and Onset of Chronic Hypertension
- Women with a history of hypertensive disorder of pregnancy (pre-eclampsia or gestational hypertension) are at increased risk of developing chronic hypertension within the first few years after delivery.
What is the impact of hypertensive disorders of pregnancy (HDP) on the onset of chronic hypertension in primiparous women in the first years following childbirth?
Data from the French National Health Data System were analyzed. Primiparous women without pre-existing chronic hypertension who delivered between 2010–2018 were included and followed from 6 weeks postpartum until onset of hypertension, a cardiovascular event, death, or the study end date. The primary outcome was diagnosis of chronic hypertension.
Of 2,663,573 women (mean follow-up 3.0 years), 180,063 (6.7%) had a diagnosis of HDP (66,260 [2.2%] had pre-eclampsia and 113,803 [4.3%] had gestational hypertension). In comparison to women without HDP, the fully adjusted hazard ratios of chronic hypertension were as follows:
- Gestational hypertension: 6.03 (95% confidence interval [CI], 5.89–6.17)
- Pre-eclampsia (all types): 8.10 (95% CI, 7.88–8.33)
- Early onset pre-eclampsia: 12.95 (95% CI, 12.29–13.65)
- Severe pre-eclampsia: 9.90 (95% CI, 9.53–10.28)
- Pre-eclampsia following gestational hypertension: 13.17 (95% CI, 12.74–13.60)
Longer duration of HDP was an additional risk factor for development of chronic hypertension.
HDPs were associated with a significantly higher risk of chronic hypertension in the first years after delivery.
While prior literature has established the increased risk of chronic hypertension among women with an HDP, this study adds to our knowledge in the following ways:
- The risk of chronic hypertension is increased within just a few years of delivery (rather than decades later). The mean age of women in this cohort was 28 ± 5 years. The mean follow-up time was 3.0 years (interquartile range, 1.3-4.2 years).
- Different subtypes of HDP carried variable risk of chronic hypertension, with gestational hypertensive the least, early onset pre-eclampsia the most, and the combination of superimposed pre-eclampsia on gestational hypertension the highest.
Identifying women at risk for chronic hypertension and ensuring proper treatment is essential for preventing long-term cardiovascular complications of untreated long-standing hypertension.
Future studies could explore whether changes in the management of HDP would lead to changes in outcomes. For example, low-dose aspirin is increasingly used for the prevention of pre-eclampsia in pregnant women with risk factors, and stricter pharmacologic treatment of hypertension during pregnancy has recently been suggested by the CHAP trial (N Engl J Med 2022;386:1781-92).
Keywords: Aspirin, Blood Pressure, Hypertension, Pregnancy-Induced, Postpartum Period, Pre-Eclampsia, Pregnancy, Primary Prevention, Risk Factors, Women
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