Hypertensive Disorders of Pregnancy and Onset of Chronic Hypertension

Sep 26, 2022
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Authors:
Bouchern P, Lailler G, Moutengou E, et al.
Citation:
Hypertensive Disorders of Pregnancy and Onset of Chronic Hypertension in France: The Nationwide CONCEPTION Study. Eur Heart J 2022;43:3352-3361.
Summary By:
Melinda Davis, MD, FACC

Quick Takes

  • Women with a history of hypertensive disorder of pregnancy (pre-eclampsia or gestational hypertension) are at increased risk of developing chronic hypertension within the first few years after delivery.

Study Questions:

What is the impact of hypertensive disorders of pregnancy (HDP) on the onset of chronic hypertension in primiparous women in the first years following childbirth?

Methods:

Data from the French National Health Data System were analyzed. Primiparous women without pre-existing chronic hypertension who delivered between 2010–2018 were included and followed from 6 weeks postpartum until onset of hypertension, a cardiovascular event, death, or the study end date. The primary outcome was diagnosis of chronic hypertension.

Results:

Of 2,663,573 women (mean follow-up 3.0 years), 180,063 (6.7%) had a diagnosis of HDP (66,260 [2.2%] had pre-eclampsia and 113,803 [4.3%] had gestational hypertension). In comparison to women without HDP, the fully adjusted hazard ratios of chronic hypertension were as follows:

  • Gestational hypertension: 6.03 (95% confidence interval [CI], 5.89–6.17)
  • Pre-eclampsia (all types): 8.10 (95% CI, 7.88–8.33)
  • Early onset pre-eclampsia: 12.95 (95% CI, 12.29–13.65)
  • Severe pre-eclampsia: 9.90 (95% CI, 9.53–10.28)
  • Pre-eclampsia following gestational hypertension: 13.17 (95% CI, 12.74–13.60)

Longer duration of HDP was an additional risk factor for development of chronic hypertension.

Conclusions:

HDPs were associated with a significantly higher risk of chronic hypertension in the first years after delivery.

Perspective:

While prior literature has established the increased risk of chronic hypertension among women with an HDP, this study adds to our knowledge in the following ways:

  1. The risk of chronic hypertension is increased within just a few years of delivery (rather than decades later). The mean age of women in this cohort was 28 ± 5 years. The mean follow-up time was 3.0 years (interquartile range, 1.3-4.2 years).
  2. Different subtypes of HDP carried variable risk of chronic hypertension, with gestational hypertensive the least, early onset pre-eclampsia the most, and the combination of superimposed pre-eclampsia on gestational hypertension the highest.

Identifying women at risk for chronic hypertension and ensuring proper treatment is essential for preventing long-term cardiovascular complications of untreated long-standing hypertension.

Future studies could explore whether changes in the management of HDP would lead to changes in outcomes. For example, low-dose aspirin is increasingly used for the prevention of pre-eclampsia in pregnant women with risk factors, and stricter pharmacologic treatment of hypertension during pregnancy has recently been suggested by the CHAP trial (N Engl J Med 2022;386:1781-92).

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, Hypertension

Keywords: Aspirin, Blood Pressure, Hypertension, Pregnancy-Induced, Postpartum Period, Pre-Eclampsia, Pregnancy, Primary Prevention, Risk Factors, Women


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