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.

Factors Involved in Endothelial Dysfunction Related to Angiogenic Disbalance and Oxidative Stress, in Women at High Risk of Term Pre-Eclampsia

“…ADMA levels are lower in normal pregnant women than in non-pregnant women. In pregnancies complicated by PE, ADMA levels are significantly higher than in the control group of the same gestational age [ 33 , 34 , 35 ], and a higher concentration of ADMA in patients with early-onset PE is related to the severity of PE [ 36 ]. ADMA has been shown to increase systemic vascular resistance in humans by acting as an endogenous inhibitor of NOS.…”

“…In recent years, evidence has accumulated tha suffer from PE predisposes to increased cardiovascular risk long-term in life [ 36 ], including risk of hypertension, peripheral arterial disease, coronary artery disease, and cerebrovascular disease [ 37 ]. The relationship between CVD and PE lies in endothelial dysfunction, with many studies suggesting that the persistence of this dysfunction postpartum is what contributes to the onset of diseases such as diabetes, hypertension, and increased risk of CVD [ 4 ].…”

Defective Uteroplacental Vascular Remodeling in Preeclampsia: Key Molecular Factors Leading to Long Term Cardiovascular Disease

“…A recent recommendation by the American Heart Association suggests initiation of screening for CVD as soon as possible after delivery in women with HDP. The suggested strategies include: (1) an interdisciplinary approach for early identification of CVD risk factors, (2) continuous postpartum visits starting six to eight weeks postpartum and annually thereafter, (3) consistent monitoring of blood pressure and biomarkers at clinic and at home, and (4) educating patients about their individual risk and helpful lifestyle modifications to prevent CVD [ 143 ].…”

The Hypertensive Disorders of Pregnancy: A Focus on Definitions for Clinical Nephrologists

“…This paradigm shift has led to an increased need for integrated care for women who experience a hypertensive disorder during pregnancy, involving specialists that can oversee and coordinate treatment, and, whenever possible, work to identify risk factors and correct them [ 1 , 2 ].…”