High Blood Pressure in Pregnancy

The Risk of Elevated Blood Pressure During Pregnancy
Elevated blood pressure during pregnancy, regardless of type and even without known risk factors, raises a woman’s risk of later cardiovascular disease, chronic kidney disease and diabetes mellitus. This has been confirmed in the Northern Finland Birth Cohort 1966, recently published in the February 12, 2013 issue of Circulation. Blood pressure measurements and other prospective data were determined from prenatal records and questionnaires for 10,314 women. Subsequent diagnoses were ascertained from Finnish registries over the following 4 decades, with an average follow–up of 39.4 years. The presence of 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 cardiovascular diseases. Specifically, gestational hypertension was associated with increased risk of ischemic heart disease, myocardial infarcts, myocardial infarct death, heart failure, ischemic stroke, kidney disease and diabetes mellitus. These results were similar in nonsmoking women

High Blood Pressure is a Signal of Later Risk
In conclusion, elevated blood pressure during pregnancy, regardless of type and even without known cardiovascular risk factors, represents a signal of a woman’s increased risk of later cardiovascular disease, chronic kidney disease and diabetes mellitus. This risk is higher than previously expected, and is noticeably higher than like women who didn’t have elevated blood pressure during pregnancy.

The Recommendation
My recommendation is early intervention in these women. We have already recognized the associated increased cardiovascular risk of preeclampsia, and have included preeclampsia in the guidelines (Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women – 2011 Update) as a risk factor for heart disease and stroke. Based on this study, we need to assess cardiovascular risk in all women who have experienced hypertension during pregnancy and not just those diagnosed clinically with preeclampsia. More importantly, we need to educate our colleagues in Obstetrics of this information, and encourage early cardiovascular risk reduction for all women who have had elevated blood pressure during pregnancy.

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