More evidence ties extreme hypertension in pregnancy to long-term problems

Women who develop preeclampsia, a form of dangerously high blood pressure during pregnancy, may face a wide variety of heart problems long after they give birth, a research review concludes. 

Preeclampsia has long been linked to an increased risk of events like heart attacks and strokes years later, but women often don’t experience symptoms until they have a life-threatening problem. For the current analysis, researchers examined results from 13 previously published studies that assessed women’s hearts with echocardiography to look for early warning signals. 

“Previous studies had demonstrated cardiac dysfunction in women with a history of pre-eclampsia but this paper brings together the results of those studies to try and better understand the extent of the problem and the patterns of dysfunction,” said lead author Archana Thayaparan, a researcher at Western Health in Victoria, Australia. 

“This is important for patients as no large studies have been done to investigate this, and most women with pre-eclampsia are unaware of the potential long-term consequences and increased risk of heart disease and stroke,” Thayaparan said by e-mail. 

So-called gestational hypertension, when women who normally don’t have high blood pressure develop it during pregnancy, is fairly common, affecting 6 per cent to 8 per cent of pregnant women. This condition can progress to a more serious and potentially life-threatening version of high blood pressure known as preeclampsia later in pregnancy. 

Women with preeclampsia are more likely to develop “diastolic dysfunction”, which happens when the heart doesn’t fill with blood properly and is a precursor to a form of heart failure. 

In the study, about 19 per cent of women with a history of preeclampsia developed diastolic dysfunction, compared with 5.4 per cent of women with uncomplicated pregnancies. 

With a history of preeclampsia, about 25 per cent of women went on to develop heart failure within 4 to 10 years of giving birth, compared with 7 per cent of women with uncomplicated pregnancies, researchers note in the Australasian Journal of Ultrasound Medicine. 

This suggests that women with a history of preeclampsia should get regular echocardiograms to monitor their hearts for changes that might not yet be causing any symptoms, the study authors conclude. 

The study wasn’t designed to determine whether preeclampsia directly causes later heart problems, or if it might be an early sign of existing problems that emerge under the pressure of pregnancy on a woman’s body. 

“Previous research has shown that traditional cardiovascular risk factors such as BMI and blood pressure play a central role in the development of cardiovascular disease in women who experienced preeclampsia,” said Eirin Haug, a public health researcher at the Norwegian University of Science and Technology in Trondheim, who wasn’t involved in the study. 

Doctors currently advise women with a history of preeclampsia to make lifestyle changes like losing weight, exercising, and eating a heart-healthy diet and to get regular blood pressure checks, Haug said by e-mail. 

“We still lack evidence for the effect of screening and lifestyle modifications on reducing cardiovascular risk in these women,” Haug said. “More research is needed to tailor effective strategies to prevent cardiovascular disease in this group of women.”