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Dr. Gregory Weiss provides perspective on a recent study suggesting women with gestational hypertension were at an increased risk of chronic hypertension later in life.
Hypertension disorders of pregnancy (HDP) are serious conditions that affect nearly one-quarter of all pregnancies and are currently the leading cause of perinatal maternal death around the world.1 It was previously known that HDP were associated with increased risk for cardiovascular disease (CVD) as far out as 20 or more years after the pregnancy, however, short term risk had yet to be defined.
Gestational hypertension or preeclampsia is defined as persistent elevated blood pressures during pregnancy and may put the lives of the mother and baby at risk in the short term. A great deal of focus has been put on the acute treatment of HDP due to the potential for loss of life prior to or even after delivery of the infant. The period over the next ten years following delivery has not been studied extensively.
Lisa Levine, MD, and colleagues sought to describe the prevalence of cardiovascular disease among women with HDP as compared to those without over the ten-year period following their pregnancy.1 The authors compared 84 patients with a history of HDP with 51 who did not.1 Of special note, 85% of participants were of African American race.1
The results of the study revealed that women who experienced a HDP were 2.4 times more likely to experience new hypertension over the next 10 years compared to women who did not.1 Interestingly, while HDP predisposed women to hypertension, there was no increased risk for other CVD risk factors such as diabetes and no differences in key cardiovascular tests such as echocardiography and endothelial function tests.1
What these results mean is that simply suffering from a hypertensive disorder of pregnancy puts a woman at risk for chronic hypertension within the next ten years.1 In addition to making this discovery, the authors noted that many of the women enrolled, including those who developed HDP and those who did not, may have had undiagnosed stage 1 or 2 hypertension prior to becoming pregnant.1 This realization underscores the need for better screening and diagnosis regardless of pregnancy.
“[This study] along with studies with similar findings, further highlights the importance of routine screening for hypertension in this population,” Levine added. “Future studies should evaluate the optimal time period to screen for postpartum hypertension and a monitoring plan for these at-risk women.”
One important difference between this study and prior investigations was the inclusion of a diverse racial cohort. A lack of racial diversity in prior studies made extrapolation to a greater population difficult at best. Too many studies lack such diversity, a fact that ignores the plain truth that many diseases, hypertension in particular, disproportionally affect people of color.
Although these results may seem intuitive the post-partum period may see many women slip under the radar especially if they have a relatively uneventful delivery. Because obstetrics is a specialty unto itself, continuity of care and referrals to general practitioners and in the case of new hypertension internists and cardiologists may be lacking. The first inclination of a new mother is to go home and take care of her baby. Nevertheless, this study uncovers an important opportunity that should not be missed by obstetricians. Knowing that hypertension during pregnancy places the parturient at twice the risk for short term hypertension thereafter necessitates referral and close follow up.
It is important for all patients including young mothers who are often taken for granted as being healthy to be screened and treated appropriately. We know that hypertension puts these women at risk for the same cardiovascular outcomes as the general population. Postpartum cardiovascular care should include a referral plan that includes the regular monitoring of blood pressures and treatment as needed ongoing.