Long-Term Cardiovascular Disease Risk in Women After Hypertensive Disorders of Pregnancy: Recent Advances in Hypertension

Abstract

Patients with a history of hypertensive disorders of pregnancy (HDP) suffer higher rates of long-term cardiovascular events including heart failure, coronary artery disease, and stroke. Cardiovascular changes during pregnancy can act as a natural stress test, subsequently unmasking latent cardiovascular disease in the form of HDP. Because HDP now affect 10% of pregnancies in the United States, the American Heart Association has called for physicians who provide peripartum care to promote early identification and cardiovascular risk reduction. In this review, we discuss the epidemiology, pathophysiology, and outcomes of HDP-associated cardiovascular disease. In addition, we propose a multi-pronged approach to support cardiovascular risk reduction for women with a history of HDP. Additional research is warranted to define appropriate blood pressure targets in the postpartum period, optimize the use of pregnancy history in risk stratification tools, and clarify the effectiveness of preventive interventions. The highest rates of HDP are in populations with poor access to resources and quality health care, making it a major risk for inequity of care. Interventions to decrease long-term cardiovascular disease risk in women following HDP must also target disparity reduction.

Keywords: cardiovascular disease; hypertension; preeclampsia; pregnancy; risk factors.

Figure 1.. Strategies for cardiovascular disease (CVD) risk reduction following hypertensive disorders of pregnancy.

Suggested strategies include a multidisciplinary team-based approach for early identification of CVD risk factors, consistent monitoring and education. HDP indicates hypertensive disorders of pregnancy; NP, nurse practitioner; and Ob-gyn, obstetrician-gynecologist.

Figure 2.. Timeline for primary prevention of cardiovascular disease (CVD) following hypertensive disorders of pregnancy.

Primary prevention of CVD should start early in the postpartum period and continue throughout the women’s life. BMI indicates body mass index; BP, blood pressure; CVD, cardiovascular disease; and HDP, hypertensive disorders of pregnancy (Adapted from the Obstetrics Guidelines 2020 of the Norwegian Society of Gynecology and Obstetrics with permission).