The study also shows that more than half of study participants met criteria for at least stage 1 hypertension but had not received a formal diagnosis, underscoring the importance of screening for hypertension in pregnant women. High blood pressure affects almost 20% of all pregnant women and is one of the main causes of maternal deaths worldwide. These patients with this history and no diagnosis are at very high long-term risk for heart disease and cerebrovascular accidents (CVA).
In these women, most events develop 20 to 30 years after pregnancy.
Therefore, women who have unknowingly developed asymptomatic gestational hypertension or preeclampsia still have an increased cardiovascular risk many years after pregnancy and could benefit from preventive treatment.
The study: Here, researchers assess the prevalence of cardiovascular risk factors and cardiovascular disease in women with and without gestational hypertension at approximately 10 years of age. The 135 participants, including 84 with a history of gestational hypertension, underwent echocardiography, arterial tonometry, and flow-mediated brachial artery dilation, a test to assess endothelial function. The analysis shows the following:
- Patients with a history of hypertension therefore have a 2.4 times higher risk of developing hypertension 10 years later than patients without a history (56% vs. 23.5%);
- 80% of patients with a history of hypertension vs. 60% with no history presented 10 years later with stage 1 or 2 hypertension;
- among these patients, only 39% with a history of hypertension had been formally diagnosed before being included in the study;
- however, no association has been found between such a history and other cardiovascular risk factors such as diabetes or obesity;
- no association was found with noninvasive subclinical measures of cardiovascular risk, including measures of left ventricular structure, global longitudinal stress, or endothelial function.
The lead author Dr. Lisa Levine, director of the Cardiac Prevention and Pregnancy Program, Philadelphia Hospital, concludes that hypertension itself explains much of the future cardiovascular risk in women with a history of heart disease.
Although an increased risk of hypertension after gestational hypertension or preeclampsia is not a discovery, the study shows that the risk sometimes persists for several decades after pregnancy and therefore requires not only detection during pregnancy but long-term cardiovascular monitoring of affected women.
Therefore, new interventions need to be developed to improve cardiovascular surveillance and care after birth.