Elevated Blood Pressure in Pregnancy and Subsequent Chronic Disease Risk

Abstract

Background Preeclampsia, a new-onset hypertensive disorder of pregnancy, is associated with lifetime cardiovascular disease risk, but less is known about risk after other pregnancy-related hypertension. Methods and Results The Northern Finland Birth Cohort 1966 included all expected births from 1 year (N=12 055 women). Blood pressure measurements and other prospective data were determined from prenatal care records and questionnaires for 10 314 women. Subsequent diagnoses were ascertained from Finnish registries (average follow-up, 39.4 years). Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) estimate risks in hypertensive women compared with normotensive women. Hypertension during pregnancy was associated with increased risk of subsequent cardiovascular disease and arterial hypertension. Women with chronic hypertension and superimposed preeclampsia/eclampsia had high risk for future diseases. Gestational hypertension was associated with increased risk of ischemic heart disease (HR, 1.44 [95% CI, 1.24–1.68]), myocardial infarcts (HR, 1.75 [95% CI, 1.40–2.19]), myocardial infarct death (HR, 3.00 [95% CI, 1.98–4.55]), heart failure (HR, 1.78 [95% CI, 1.43–2.21]), ischemic stroke (HR, 1.59 [95% CI, 1.24–2.04]), kidney disease (HR, 1.91 [95% CI, 1.18–3.09]), and diabetes mellitus (HR, 1.52 [95% CI, 1.21–1.89]). Isolated systolic hypertension was associated with increased risk of myocardial infarct death (HR, 2.15 [95% CI, 1.35–3.41]), heart failure (HR, 1.43 [95% CI, 1.13–1.82]), and diabetes mellitus (HR, 1.42 [95% CI, 1.13–1.78]), whereas isolated diastolic hypertension was associated with increased risk of ischemic heart disease (HR, 1.26 [95% CI, 1.05–1.50]). Results were similar in nonsmoking women aged <35 years with normal weight and no diabetes mellitus during pregnancy. Conclusions Elevated blood pressure during pregnancy, regardless of type and even without known risk factors, signals high risk of later cardiovascular disease, chronic kidney disease, and diabetes mellitus. Clinical monitoring, risk factor evaluation, and early intervention could benefit women with hypertension in pregnancy.

Hypertensive Disorders of Pregnancy and Future Maternal Cardiovascular Risk

“…A study of a Finnish cohort with 39 years of follow‐up found that GH was associated with modestly higher CVD risk than preeclampsia (HR: 1.45 versus 1.40) 44. Of note, the risk of future coronary artery disease, heart failure, hypertension, cerebrovascular disease, DM, and chronic kidney disease in this study were all found to be higher with GH than with preeclampsia in this study.…”

“…More specifically, one meta‐analysis demonstrated a 4.2‐fold increased risk of heart failure, a 2.5‐fold increased risk of coronary artery disease, and a 1.8‐fold increased risk of stroke in women with preeclamptic pregnancies over a follow‐up period of up to 39 years 42. The risk of future hypertension is even more pronounced, with increased risk ranging from 2.3‐ to 6.7‐fold among women with prior preeclampsia 38, 40, 43, 44. These women also have roughly double the risk of venous thromboembolism and 4 times the risk of DM compared with those with normotensive pregnancies 38, 45.…”

“…It has been shown, however, that isolated systolic and diastolic hypertension during pregnancy are associated with increased risk of subsequent hypertension and CVD 44. Another study reported that modestly elevated BP during pregnancy (>120/80 mm Hg without HDP) was associated with a 2.6‐fold higher risk of chronic hypertension in the decade after delivery compared with women with lower BP 54.…”

Impact of a History of Hypertension in Pregnancy on Later Diagnosis of Atrial Fibrillation

“…The increasing prevalence of overweight and obesity worldwide,20 aside from increasing AF prevalence, may also partially account for the increase in HPD prevalence 8, 21. The increase in AF in women with a history of HPD may be as a direct consequence of persistent structural and functional myocardial changes that occur during HPDs; or future hypertension that occurs earlier in life6 and at higher rates in women with HPD versus those with normotensive pregnancies 5. An echocardiographic study evaluating the prevalence of left ventricular hypertrophy following hypertensive pregnancy showed that the increase in prevalence was likely explained by a longer duration of chronic hypertension 13.…”

“…Women with a history of a hypertensive pregnancy disorder (HPD) are ≈4 times more likely to develop hypertension later in life,4, 5 and also develop hypertension ≈10 years earlier than women who have had normotensive pregnancies 6. Hypertension in pregnancy is common, occurring in up to 10% of pregnancies worldwide,7 and may be increasing in prevalence 8.…”