Pregnancy Hypertension to Chronic Hypertension – Weight Matters

by Ashley Jordan Ferira, PhD, RDN

An analysis of the Nurses’ Health Study II (NHS2) cohort revealed that women with a history of hypertensive disorders of pregnancy (HDP) who are also overweight or obese have a significantly increased risk of developing chronic hypertension (HTN) later in life.¹

HDP includes pre-eclampsia and gestational HTN: obstetric complications increasing risk of maternal mortality.² In the US, pre-eclampsia and gestational HTN affect 3% and 5-10% of pregnancies, respectively.² Furthermore, HDP increases risk for chronic HTN. Conservative figures estimate that 1 in every 3 US adults has HTN, which increases the risk for heart attack, stroke, heart failure, kidney disease, and mortality.^3-4

Due to a paucity of evidence regarding prevention of chronic HTN in women with a history of HDP, researchers from Brigham and Women’s Hospital and Harvard University investigated the impact of lifestyle risk factors on development of chronic HTN in patients with history of HDP.¹

The prospective NHS2 cohort included 54,588 women aged 32-59 years. Ten percent of women had diagnosed HDP at baseline, and 13,971 cases of physician-diagnosed chronic HTN which occurred during the 22-year follow up. Lifestyle factors considered were post-pregnancy BMI, adherence to the Dietary Approaches to Stop Hypertension (DASH) diet, and dietary sodium and potassium intake.

Major findings included:¹

• Regardless of HDP history, overweight and obesity were consistently associated with increased risk for developing chronic HTN
• In women with a HDP history, overweight and obesity further increased risk of developing chronic HTN
• In women aged 40-49 years with previous HDP and obesity class I (BMI 30-34.9), 25% of subsequent chronic HTN risk was likely due to obesity

Why is this Clinically Relevant?

• HTN affects at least 1 in 3 US adults²
• HDP increases risk for developing chronic HTN¹
• History of HDP combined with overweight and obesity may have a synergistic, negative effect and increase risk for chronic HTN later in life¹
• Targeted, lifestyle interventions that achieve and maintain a healthy weight are essential to attenuate the trajectory of HDP to chronic HTN

Link to article

Citations

1. Timpka S, Stuart JJ, Tanz LJ, et al. Lifestyle in progression from hypertensive disorders of pregnancy to chronic hypertension in Nurses’ Health Study II: observational cohort study. BMJ. 2017;358:j3024.
2. Lo JO, Mission JF. Hypertensive disease of pregnancy and maternal mortality. Curr Opin Obstet Gynecol. 2014;25(2):124-132.
3. Merai R, Siegel C, Rakotz M, et al. CDC Grand Rounds: A Public Health Approach to Detect and Control Hypertension. MMWR Morb Mortal Wkly Rep. 2016 Nov 18;65(45):1261-1264.
4. Mozzafarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2015 Update: a report from the American Heart Association. Circulation. 2015;e29-322.