Preeclampsia, hypertension during pregnancy doubles risk of long-term hypertension

disclosures:
Levine and Chou report no relevant financial disclosures. See the study for the relevant financial disclosures from all other authors.


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A cohort of mostly black women who developed hypertensive disease during pregnancy were 2.4 times more likely to develop hypertension 10 years later, data from a prospective study shows.

In an analysis of women who participated in a previous study that enrolled women with confirmed preeclampsia or gestational hypertension and normotensive controls, the researchers also found that differences in non-invasive measures of CV risk were primarily driven by the hypertension diagnosis, regardless of history of hypertensive disease during pregnancy.

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“There was an incredibly high prevalence of undiagnosed hypertension, where patients would not have known they had chronic hypertension if they had not participated in this study,” Lisa D. Levine, MD, MSCE, Michael T. Mennuti, MD, associate professor of reproductive health, division chief of maternal fetal medicine in the division of obstetrics and gynecology, and director of the pregnancy and heart disease program at the University of Pennsylvania Perelman School of Medicine, told Healio. “Importantly, patients with a history of preeclampsia or gestational hypertensive disease were almost 2.5 times more likely to develop chronic hypertension. Most importantly, it appears that the development of chronic hypertension itself is the driving factor in the development of future heart disease in these patients with a history of hypertensive disease during pregnancy.”

As Healio previously reportedPrevious research shows that hypertension develops more quickly in women who have had hypertensive conditions during pregnancy, up to 10 years earlier, compared to women with normotensive pregnancies.

Assessing Hypertension During Pregnancy

Lisa D. Levine

In a prospective, cross-sectional study, Levine and colleagues analyzed data from 84 patients with and 51 patients without a history of hypertensive pregnancy disorder who were randomly selected from a previous study and enrolled in a follow-up study.

“The current study included only patients without a history of heart disease, chronic hypertension, or pregestational diabetes at the time of enrollment in the original parent study (10 years earlier),” the researchers wrote. “However, patients who developed hypertension, diabetes or heart disease since the time of enrollment were included in the original study because they were considered outcomes.”

Participants underwent personal visits with echocardiography, arterial tonometry, and flow-mediated brachial artery dilation. The mean age of onset was 39 years for women with no history of hypertensive pregnancy disorder and 36 years for women with a history of hypertensive pregnancy; 85% of the patients were black. Hypertensive disorders of pregnancy were defined as gestational hypertension, as well as preeclampsia and superimposed preeclampsia, with or without severe features.

The findings were published in the Journal of the American College of Cardiology.

Researchers found that patients with a history of gestational hypertensive disease had a 2.4-fold increased risk of new hypertension compared to patients without gestational hypertensive disease (adjusted RR = 2.4; 95% CI 1.39-4.14) without differences in measures of left ventricular structure, global longitudinal tension, diastolic function, arterial stiffness, or endothelial function.

Regardless of having a history of hypertensive disease during pregnancy, those who developed hypertension had greater LV remodeling, including greater relative wall thickness, as well as poorer diastolic function, including lower septal and lateral e’- and E/A ratio. Those who developed hypertension also showed more abnormal longitudinal tension and higher effective arterial elasticity compared to patients without hypertension.

“These data emphasize the importance of screening patients for the development of hypertension and ensuring that patients and healthcare providers are aware of this risk,” Levine told Healio. “Future studies should focus on ways to ensure that patients and caregivers know the overall risk of hypertension following hypertensive conditions of pregnancy, determine best screening practices (how often to screen, screen with home blood pressure, in-office, etc.) diagnosis, screening and treatment may prevent future CVD associated with hypertensive disorders of pregnancy.”

‘Multiple solutions’ needed

In a related editorial, Josephine C. Chou, MD, MS, of the Department of Cardiovascular Medicine at Yale University School of Medicine, wrote that black patients are disproportionately affected by hypertensive conditions of pregnancy and their complications; however, it is important to recognize race as a social construct and not as an inherent risk factor for disease.

“There are additional hypertensive conditions of gestational heterogeneity in black patients because of differences in socioeconomic indices (employment, income, education, social security) as well as birth and length of stay in the US,” Chou wrote. Accumulated lifelong stress from structural racism, housing segregation and ongoing discrimination also negatively impacts health and contributes to hypertensive disorders of pregnancy and CVD. Addressing disparate hypertensive disorders of pregnancy and CV outcomes requires thus, multifaceted solutions targeting medical and societal inequalities, as well as psychological and community factors.”

Reference:

For more information:

Lisa D. Levine, MD, MSCE, can be reached at lisa.levine@pennmedicine.upenn.edu† Twitter: @lisaobdoc.

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