HYPERTENSIVE disorders of pregnancy (HDP) are a leading cause of maternal death globally. Females with a history of HDP also have an increased long-term risk of heart disease and stroke. The majority of these events occur 20–30 years after pregnancy. Many individuals are asymptomatic 5–10 years post-HDP and consequently do not seek care. Despite this, they are still at heightened cardiovascular risk and could benefit from preventative healthcare.
A recent study assessed the prevalence of cardiovascular (CV) risk factors and CV disease among females who did and did not experience HDP 10 years prior. Participants underwent in-person visits with echocardiography, arterial tonometry, and flow-mediated dilation of the brachial artery. In total, assessments were completed for 135 females: 84 had a history of HDP and 51 did not. Of note, 85% of participants were Black. Lead author Lisa Levine, Director of the Pregnancy and Heart Disease Program at the Hospital of the University of Pennsylvania, Philadelphia, USA, emphasised that studying a more diverse population is crucial because both HDP and CV disease disproportionately affect females who are Black.
Overall, females with a history of HDP had a 2.4-fold increased risk of new hypertension compared with those who did not experience gestational hypertension or pre-eclampsia. Further, there was no association with other CV risk factors and no differences were observed in non-invasive subclinical measures of CV risk. The researchers also highlighted that hypertension itself explained a large portion of future CV risk for females with prior HDP.
Although this is not a new finding, other studies have been limited by factors such as a lack of racial diversity, small cohort sizes, and limited assessment of broad cardiovascular phenotyping. Therefore, the current study is the most comprehensive to date.
In addition, more than 80% of patients with a history of HDP and 60% of those who had not experienced HDP had either Stage 1 or Stage 2 hypertension. However, only 39% of patients with prior HDP had received a formal diagnosis before being screened as part of the trial. According to Levine, these research results illustrate the importance of routine screening for hypertension in this population.
Going forward, there is a need to evaluate the optimal time period to screen for postpartum hypertension. Future studies should also focus on monitoring plans for at-risk females. Ultimately, this could pave the way for reducing maternal and pregnancy-related morbidity and mortality across the globe.
