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Hypertension in pregnancy: an emerging risk factor for cardiovascular disease

Nature Clinical Practice Nephrology volume 3, pages 613–622 (2007)Cite this article

Abstract

Increasing evidence indicates that hypertension in pregnancy is an under-recognized risk factor for cardiovascular disease (CVD). Compared with women who have had normotensive pregnancies, those who are hypertensive during pregnancy are at greater risk of cardiovascular and cerebrovascular events and have a less favorable overall risk profile for CVD years after the affected pregnancies. One factor that might underlie this relationship is that hypertensive disorders of pregnancy (pre-eclampsia, in particular) and CVD share several common risk factors (e.g. obesity, diabetes mellitus and renal disease). Alternatively, hypertension in pregnancy could induce long-term metabolic and vascular abnormalities that might increase the overall risk of CVD later in life. In both cases, evidence regarding risk-reduction interventions specific to women who have had hypertensive pregnancies is lacking. While awaiting results of large-scale studies, hypertensive disorders of pregnancy should be screened for during assessment of a woman's overall risk profile for CVD. Women at high risk must be monitored closely for conventional risk factors that are common to both CVD and hypertensive disorders of pregnancy and treated according to current evidence-based national guidelines.

Key Points

  • Compared with women who have a history of normotensive pregnancy, those who have a history of hypertensive disorders of pregnancy are at higher risk of cardiovascular and cerebrovascular events, and have a less favorable cardiovascular disease (CVD) risk profile, years after the affected pregnancy

  • Hypertensive disorders of pregnancy and CVD share several common risk factors; for example, obesity, diabetes and renal disease

  • Hypertension in pregnancy might modify the future risk of CVD by inducing long-term metabolic and vascular changes

  • Increasing evidence indicates that a history of hypertensive pregnancy is an under-recognized risk factor that could aid early identification of women who are at an increased risk of developing CVD

  • Women with a history of hypertensive pregnancy must be monitored closely for comorbidities and conventional risk factors for CVD and treated according to current evidence-based guidelines

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Figure 1: Endothelial dysfunction is common to both cardiovascular disease and several hypertensive disorders of pregnancy, particularly pre-eclampsia.

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Acknowledgements

Désirée Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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  1. VD Garovic is a Consultant and Assistant Professor in the Division of Nephrology and Hypertension, and SR Hayman is a Consultant and Assistant Professor in the Division of Hematology, at the Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.,

    Vesna D Garovic & Suzanne R Hayman

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Correspondence to Vesna D Garovic.

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Garovic, V., Hayman, S. Hypertension in pregnancy: an emerging risk factor for cardiovascular disease. Nat Rev Nephrol 3, 613–622 (2007). https://doi.org/10.1038/ncpneph0623

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