Heart abnormalities in older Hispanic women linked to high blood pressure during pregnancy

Hispanic women diagnosed with high blood pressure for the first time during pregnancy may face a higher risk of developing abnormalities in heart function and structure later in life, a new study suggests.

The findings could have significant health implications for women who develop hypertensive disorders of pregnancy, such as gestational hypertension, preeclampsia and eclampsia, researchers said. Previous studies have associated such pregnancy complications with an increased risk for cardiovascular disease and even death. The new findings suggest structural and functional changes in the heart may be what’s driving that increased risk.

The changes can be detected with an echocardiogram, an ultrasound of the heart, before the outward signs and symptoms of heart disease manifest. That information could be key to early prevention of cardiovascular disease and death, though more research is needed, said Dr. Odayme Quesada, lead author of the study, published this week in the American Heart Association journal Hypertension.

“Essentially, what this study tells us is that hypertension in pregnancy has lasting effects on heart health,” said Quesada, a cardiologist and medical director of the Women’s Heart Center and the Ginger Warner Endowed Chair in Women’s Cardiovascular Health at The Christ Hospital in Cincinnati. The findings underscore the need for physicians to recognize that high blood pressure during pregnancy can increase heart disease risk in their patients and to consider this when evaluating women’s future risk, she said.

The rate of hypertensive disorders of pregnancy more than doubled in the U.S. between 2007 and 2019, according to a 2022 study in the Journal of the American Heart Association that showed the rate among Hispanic women reached more than 60 cases per 1,000 live births.

For the new study, researchers examined the echocardiograms of 5,168 Hispanic women taking part in the Hispanic Community Health Study/Study of Latinos, the largest study of the health of Hispanic and Latino adults in the United States. Their average age was 59, and they had been pregnant at least once.

About 14% reported having high blood pressure for the first time while pregnant: 439 of them had gestational hypertension, 219 had preeclampsia and 66 had eclampsia.

Researchers also found that high blood pressure during pregnancy was associated with lower ejection fraction, which measures the heart’s ability to pump blood to the body; increased thickness of the left ventricle wall; and a higher risk of having abnormal left ventricle geometry. This is important because all are known indicators of future cardiovascular disease and death, Quesada said.

In addition, the findings show that the changes seen in heart structure and function were only partly explained by having high blood pressure again later in life, Quesada said. For example, just 14% of the risk for abnormal left ventricle geometry was related to chronic hypertension.

Physicians do not generally order heart ultrasounds for women unless they are showing signs or symptoms of heart disease, Quesada said. More research is needed to determine whether echocardiograms are warranted in symptom-free women who had high blood pressure during pregnancy to detect abnormalities that may need early treatment, she said.

Dr. Maria Carolina Gongora, a cardiologist and assistant professor of medicine in the division of cardiology at Emory University in Atlanta, said it’s common practice for new mothers to be sent home without an echocardiogram once the postpartum high blood pressure resolves, unless there are signs of heart involvement.

“But this study suggests that these women need to be on the radar for development of cardiac disease, even when their blood pressure normalizes, which I don’t think we are currently doing,” she said.

Gongora, who was not involved with the study, said new mothers who develop hypertension during pregnancy need to be made aware of long-term risks of heart disease. It may be one of the few early opportunities that a woman has to learn about any increased risk of having cardiovascular disease in her future, she said.