Although the prevalence of chronic hypertension in pregnancy doubled in the US between 2007 and 2021 only about 60% of pregnant women with the potentially fatal condition received antihypertensive medication according to a study of nearly 2 million pregnancies funded by the National Institutes of Health (NIH). The National Institutes of Health (NIH)’s National Heart Lung and Blood Institute (NHLBI) provided funding for the research. The researchers postulated that rising obesity rates aging mothers and other variables were probably responsible for the increase even though they did not look into the reasons for it
“The high rate of maternal deaths in the US, linked to ongoing hypertension during pregnancy, makes these results very concerning,” stated Stephanie Leonard, Ph.D., the study’s lead researcher and an epidemiologist at Stanford University School of Medicine in California. “Even though there are safe and effective treatments for persistent hypertension, the study emphasizes the urgent need for improvements in care for this deadly condition.”
Chronic hypertension associated with pregnancy is defined as blood pressure that is continuously high, 140/90 mm Hg or more, either before or during the first 20 weeks of pregnancy. The sickness can damage an expectant mother’s organs and increases the risk of low birthweight or early birth. It can be fatal if undetected and mistreated.
The findings is particularly relevant to Black, American Indian, and Alaska Native communities because these groups have the highest rates of poor maternal health outcomes and pregnancy-related deaths nationwide.
“Even in these high-risk categories, we need to better identify gaps in therapy for persistent hypertension,” said Candice A. Price, Ph.D., program director at NHLBI and specialist in women’s health research. “If we don’t identify and treat persistent hypertension early on, we’re missing out on an opportunity to preserve heart health both during and after pregnancy.”
Using a large database of U.S. commercial insurance claims from 2007 to 2021, researchers looked at the prevalence of chronic hypertension and the usage of oral antihypertensive medication among 1.9 million pregnant people aged 12-55.
The study found that the percentage of pregnant women with chronic hypertension more than doubled, rising from 1.8% in 2008 to 3.7% in 2021. They also found that during the course of the trial, the percentage of patients with chronic hypertension who used antihypertensive medication rose from 58% to barely 60%.
Leonard noted that the sharp increase in chronic hypertension during pregnancy was consistent with patterns in both the general adult population in the United States and earlier eras of hypertension observation, despite the fact that the study did not focus on the reason of the increase.
An earlier analysis of national data from 1970 to 2010, for example, suggested that women who gave birth later in life might have had something to do with the increasing trend of chronic hypertension during pregnancy. In the current study, those with chronic hypertension tended to be older than those without the condition.
Rising rates of obesity may be a factor in the increase, along with other factors like better medical record-keeping of the frequency of chronic hypertension and increased focus in recognizing it.
The American College of Cardiology and American Heart Association revised their hypertension recommendations in 2017, lowering the bar for diagnosing hypertension in all adult populations. Leonard and colleagues looked into the potential impact of these changes. However, they did not find any correlation—at least not yet.
The blood pressure criteria have shifted: they are now greater than or equal to 140/90 mm Hg for stage 2, which carries the biggest risk to health, and 130-139/80-89 mm Hg instead of 140-159/90-109 mm Hg for stage 1 diagnosis. Leonard pointed out that assessments of the years after the 2008–2021 period she and her team looked at could show the impact of the rules.
To treat hypertension during pregnancy, experts encourage women to see their doctor frequently, take antihypertensive medications as prescribed, and keep an eye on and regulate their blood pressure at home.
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