HYPERTENSIVE disorders of pregnancy (HDP) double the long-term risk of dilated cardiomyopathy (DCM), with onset occurring a median of five years postpartum and older maternal age or postpartum hypertension further elevating risk, according to a UK cohort study of 84,498 individuals.
Hypertensive disorders such as preeclampsia and gestational hypertension complicate up to 10% of pregnancies, yet their long-term cardiovascular consequences remain understudied. This study aimed to determine whether HDP increases the risk of DCM, a condition characterised by heart muscle weakness and impaired pumping. Using linked electronic health records from England (1997–2023), researchers compared 14,083 individuals with HDP during their first pregnancy to 70,415 normotensive controls, tracking DCM incidence over a median follow-up of 15 years.
Cox proportional hazards models revealed HDP was associated with a 93% higher risk of DCM (adjusted HR 1.93, 95% CI 1.33–2.81; P=0.001), persisting after adjustment for age, socioeconomic status, and comorbidities (HR 1.55, 95% CI 1.04–2.31; P=0.03). Severe preeclampsia quadrupled the risk (HR 4.29, 95% CI 2.32–7.96; P<0.001), while gestational hypertension increased it by 85% (HR 1.85, 95% CI 1.24–2.76; P=0.002). DCM developed earlier in HDP patients (median 5.1 vs. 10.6 years postpartum). Older maternal age (HR 1.06 per year, 95% CI 1.03–1.08; P<0.001) and incident postpartum hypertension (HR 1.68, 95% CI 1.16–2.42; P=0.006) independently heightened risk.
These findings underscore the need for long-term cardiac surveillance in HDP patients, particularly those with severe preeclampsia or postpartum hypertension. Clinicians should integrate DCM screening into postnatal care pathways, emphasising blood pressure management and echocardiographic monitoring for high-risk groups. Future research should explore targeted interventions to mitigate this risk and clarify underlying mechanisms linking HDP to myocardial dysfunction.
Reference
Tayal U et al. Hypertensive Disorders of pregnancy and long-term risk of dilated cardiomyopathy. JAMA Cardiol. Published online April 02, 2025. doi:10.1001/jamacardio.2025.0328.
