Cardiovascular Risk Factor Management After Hypertensive Disorders of Pregnancy

Abstract

Hypertensive disorders of pregnancy (HDP) are associated with significantly increased risk of developing future cardiovascular disease (CVD). Obstetricians play a crucial role in CVD prevention for postpartum women and birthing people with HDP because they are primarily responsible for immediate postpartum management and can assist with care transitions to other health care practitioners for long-term management of CVD risk factors. Standardized calculators can be used to evaluate long-term CVD risk, which can help guide intensity of treatment. Emerging technologies such as remote blood pressure monitoring demonstrate promise for improving outcomes among patients with HDP. After HDP, all patients should be advised of their increased CVD risk. A plan should be made to initiate lifestyle modifications and antihypertensive therapy to achieve optimal blood pressure control with a target of lower than 130/80 mm Hg, assess lipids within 2-3 years of delivery, and evaluate for development of type 2 diabetes. Other CVD risk factors such as nicotine use should similarly be identified and addressed. In this review, we summarize the essential components of managing CVD risk after a pregnancy complicated by HDP, including blood pressure monitoring, risk stratification tools, and evidence-based lifestyle recommendations.

Figure 1:

Assessment of atherosclerotic cardiovascular disease (ASCVD) risk in individuals with hypertensive disorder of pregnancy (HDP) and statin treatment approaches Statin recommendations are based on the 2017 American College of Cardiology/American Heart Association Cholesterol Guidelines and may be modified if coronary artery calcium (CAC) score is performed.¹⁰⁰ *Statin not recommended unless other indication present, such as family history of premature ASCVD. ^†There is not agreement about optimal treatment approach and risk discussion should be performed with patient. HDP, hypertensive disorders of pregnancy.

Figure 2:

Blood pressure categories and approach to treatment for individuals with hypertensive disorder of pregnancy (HDP). *High atherosclerotic cardiovascular disease (ASCVD) risk indicated by 10-year ASCVD estimate ≥10%; low ASCVD risk indicated by age <40 years or 10-year ASCVD estimate <10%. BP, blood pressure; HTN, hypertension.

Figure 3:

Factors influencing blood pressure assessment and instructions for proper blood pressure measurement.