What percentage of patients with pre-eclampsia in pregnancy later develop chronic hypertension?

From the Guidelines

Approximately 25-30% of patients with pre-eclampsia in pregnancy will later develop chronic hypertension. This estimate is based on a meta-analysis of 3,488,160 women, including 198,252 with pre-eclampsia, which reported that after 10 to 15 years, women with pre-eclampsia had a 3.7-fold risk of hypertension 1. The development of chronic hypertension typically occurs within 5-15 years after the pre-eclamptic pregnancy, though some women may develop it sooner. Key factors that increase the risk of developing chronic hypertension after pre-eclampsia include:

• Severe pre-eclampsia
• Early-onset pre-eclampsia (before 34 weeks gestation)
• Recurrent pre-eclampsia
• Pre-eclampsia with additional complications such as HELLP syndrome The connection between pre-eclampsia and chronic hypertension exists because they share common risk factors and pathophysiological mechanisms, including endothelial dysfunction, insulin resistance, and systemic inflammation 1. Women with a history of pre-eclampsia should receive regular blood pressure monitoring after pregnancy and throughout their lives, with screenings at least annually. They should also be counseled about lifestyle modifications to reduce cardiovascular risk, including:
• Maintaining a healthy weight
• Following a low-sodium diet
• Engaging in regular physical activity
• Limiting alcohol consumption
• Avoiding tobacco use These measures can help mitigate the risk of chronic hypertension and other cardiovascular diseases in women with a history of pre-eclampsia 1.

From the Research

Pre-eclampsia and Chronic Hypertension

• Pre-eclampsia complicates about 2-8% of pregnancies 2, 3, and is associated with increased risk of maternal and fetal morbidity and mortality.
• Women with a history of pre-eclampsia are at increased risk of developing chronic hypertension later in life, although the exact percentage is not specified in the provided studies.
• Hypertensive disorders of pregnancy, including pre-eclampsia and chronic hypertension, affect about 5-10% of pregnancies 3.
• Superimposed preeclampsia complicates about 20% of pregnancies in women with chronic hypertension 4.

Risk Factors and Biomarkers

• Risk factors for pre-eclampsia include familial factors, sperm exposure, maternal smoking, pre-existing medical conditions, and miscellaneous factors such as plurality, older maternal age, and obesity 3.
• Biomarkers such as uric acid, soluble fms-like tyrosine kinase-1, and placental growth factor have been investigated for their role in predicting superimposed preeclampsia in women with chronic hypertension, but their performance is modest and not clinically useful for stratification 4.
• Proinflammatory mediators and endothelial dysfunction markers have also been studied as potential biomarkers for superimposed preeclampsia, but the evidence is limited and not conclusive 4.

Pregnancy Outcomes

• Pregnancies complicated by chronic hypertension have higher rates of adverse outcomes, including cesarean delivery, intrauterine growth restriction, perinatal mortality, and post-partum hemorrhage, even after adjusting for superimposed preeclampsia 5.
• Chronic hypertension is associated with increased risk of adverse pregnancy outcomes, regardless of superimposed preeclampsia 5.