Article Impact Level: HIGH Data Quality: STRONG Summary of Hypertension, HYPERTENSIONAHA.124.22731. https://doi.org/10.1161/HYPERTENSIONAHA.124.22731 Dr. Stephanie A. Leonard et al.
Points
- The prevalence of chronic hypertension during pregnancy increased from 1.8% to 3.7% between 2008 and 2021, according to data from the Merative™ Marketscan® Research Database.
- Despite the rise in prevalence, the use of antihypertensive medications among pregnant individuals with chronic hypertension remained relatively stable, ranging from 57% to 60%.
- There were notable shifts in antihypertensive medication choices: methyldopa and hydrochlorothiazide usage declined significantly, while labetalol and nifedipine usage increased.
- The updated 2017 hypertension guidelines by the American College of Cardiology and the American Heart Association did not lead to significant changes in the prevalence or treatment patterns of chronic hypertension during pregnancy.
- The study underscores the need for improved management strategies, as a significant proportion of pregnant individuals with chronic hypertension are not receiving antihypertensive treatment, potentially affecting maternal and fetal health outcomes.
Summary
The management of chronic hypertension during pregnancy is crucial for reducing the risk of adverse perinatal outcomes. This study investigates chronic hypertension’s prevalence and treatment patterns during pregnancy, focusing on changes post the updated 2017 hypertension guidelines by the American College of Cardiology and the American Heart Association. By analyzing data from the Merative™ Marketscan® Research Database of United States commercial insurance claims from 2007 to 2021, the study aims to provide insights into the trends in chronic hypertension prevalence and antihypertensive medication utilization among pregnant individuals.
The research reveals a steady increase in the prevalence of chronic hypertension during pregnancy, rising from 1.8% to 3.7% among 1,900,196 pregnancies between 2008 and 2021. Despite this rise, the use of antihypertensive medications among pregnant individuals with chronic hypertension remained relatively stable at 57% to 60% over the study period. Notably, there were shifts in the choice of antihypertensive medications, with methyldopa and hydrochlorothiazide usage declining (from 29% to 2% and 11% to 5%, respectively). In comparison, labetalol and nifedipine usage increased (19% to 42% and 9% to 17%, respectively). Interestingly, the introduction of the 2017 guidelines did not lead to significant changes in the prevalence or treatment patterns of chronic hypertension during pregnancy.
The study highlights a doubling in the prevalence of chronic hypertension during pregnancy over the study period, emphasizing the importance of monitoring and managing hypertension in pregnant individuals. Labetalol emerged as the predominant antihypertensive medication, replacing methyldopa. However, the findings indicate that a significant proportion of pregnant individuals with chronic hypertension are not receiving antihypertensive treatment, underscoring the need for improved management strategies to optimize maternal and fetal health outcomes in hypertensive pregnancies.
Link to the article: https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.124.22731
References Leonard, S. A., Siadat, S., Main, E. K., Huybrechts, K. F., El-Sayed, Y. Y., Hlatky, M. A., Atkinson, J., Sujan, A., & Bateman, B. T. (2024). Chronic Hypertension During Pregnancy: Prevalence and Treatment in the United States, 2008–2021. Hypertension, HYPERTENSIONAHA.124.22731. https://doi.org/10.1161/HYPERTENSIONAHA.124.22731
