From the Guidelines
Preeclampsia is associated with significant cardiovascular changes, including increased systemic vascular resistance, reduced cardiac output, and hypertension, which can lead to long-term cardiovascular consequences, such as hypertension, stroke, and ischemic heart disease, as confirmed by a 50-year follow-up study 1. The primary cardiovascular changes in preeclampsia include:
- Increased systemic vascular resistance
- Reduced cardiac output
- Hypertension, which is the hallmark clinical feature
- Endothelial dysfunction and vasospasm due to an imbalance of vasoactive substances
- Widespread vasoconstriction and reduced organ perfusion
- Increased afterload due to elevated peripheral resistance, leading to left ventricular hypertrophy in prolonged cases
- Paradoxically decreased blood volume despite edema, with reduced plasma volume and hemoconcentration
- Reduced renal perfusion and glomerular filtration rate, leading to proteinuria
- Hypercoagulability with increased risk of thrombosis due to platelet activation and consumption These cardiovascular changes result from placental ischemia triggering the release of anti-angiogenic factors like sFlt-1 and soluble endoglin, which antagonize vascular endothelial growth factor and cause widespread endothelial dysfunction. The only definitive treatment for these cardiovascular changes is delivery of the placenta, though antihypertensive medications like labetalol, nifedipine, or methyldopa may be used to manage blood pressure in the interim, as recommended by the European Society of Hypertension 1. It is essential to note that women with gestational hypertension or preeclampsia are at increased risk of developing long-term cardiovascular consequences, and therefore, cardiovascular risk assessment and lifestyle modifications are recommended to avoid complications in subsequent pregnancies and reduce maternal cardiovascular risk in the future 1.
From the Research
Cardiovascular Changes Associated with Preeclampsia
The cardiovascular changes associated with preeclampsia include:
- A hyperdynamic circulation, characterized by increased cardiac output and systemic vascular resistance 2
- Increased mean arterial blood pressure 2
- Diminished plasma volume 2
- Endothelial dysfunction, which remains after delivery and increases the risk of developing cardiovascular disease (CVD) in later life 3
Effects on Blood Pressure
- Severe preeclampsia is defined as blood pressure >160/110 mmHg with warning signs such as headache, blurring of vision, and epigastric pain 4
- Systolic blood pressure is as important as diastolic blood pressure in the diagnosis of preeclampsia 5
- Immediate induction of labor is recommended for women with gestational hypertension or preeclampsia at 37 weeks' gestation or later 5
Long-term Cardiovascular Risk
- Preeclampsia increases the lifetime risk for cardiovascular disease (CVD) 3, 6
- Endothelial dysfunction and lipid changes during pregnancy contribute to future cardiovascular risk 3
- Cardiovascular health (CVH) after severe preeclampsia is inversely related to subclinical atherosclerosis and vascular age 6
- Low CVH is associated with a larger difference between chronological age and vascular age, highlighting the importance of CVH counseling for timely cardiovascular prevention 6