Chronic Hypertension in Pregnancy: A Lens Into Cardiovascular Disease Risk and Prevention

Abstract

Hypertension is a major, modifiable risk factor for cardiovascular disease (CVD) in the United States. Over the past decade, the prevalence of chronic hypertension (CHTN) during pregnancy has nearly doubled with persistent race- and place-based disparities. Blood pressure elevations are of particular concern during pregnancy given higher risk of maternal and fetal morbidity and mortality, as well as higher lifetime risk of CVD in birthing individuals with CHTN. When identified during pregnancy, CHTN can, therefore, serve as a lens into CVD risk, as well as a modifiable target to mitigate cardiovascular risk throughout the life course. Health services and public health interventions that equitably promote cardiovascular health during the peripartum period could have an important impact on preventing CHTN and reducing lifetime risk of CVD. This review will summarize the epidemiology and guidelines for the diagnosis and management of CHTN in pregnancy; describe the current evidence for associations between CHTN, adverse pregnancy outcomes, and CVD; and identify opportunities for peripartum care to equitably reduce hypertension and CVD risk throughout the life course.

Keywords: cardiovascular diseases; eclampsia; hypertension; postnatal care; preeclampsia.

Figure.. Intergenerational transmission of chronic hypertension

Chronic hypertension and adverse pregnancy outcomes may contribute to changes in offspring cardiovascular development and subsequent blood pressure elevations throughout the life course. Shared social determinants of health between parents and offspring further contribute to the intergenerational transmission of chronic hypertension. Older woman image by Vectorportal.com; Figure created with BioRender.com.