Hypertension during pregnancy linked with dilated cardiomyopathy risk

New research shows a significant association between hypertensive disorders in pregnancy and an increased risk of developing dilated cardiomyopathy.

Hypertensive disorders of pregnancy, which affect 5-10% of pregnancies worldwide, have been linked to a two-fold increase in the risk of developing dilated cardiomyopathy (DCM), according to new research from Imperial’s National Heart and Lung Institute (NHLI). Dilated cardiomyopathy is a type of heart muscle disease that can cause the heart chambers to become thinner, making it harder for the heart to pump blood around the body. Hypertensive disorders of pregnancy encompass conditions such as gestational hypertension and preeclampsia.

We need to be vigilant for the development of DCM in women with a history of hypertensive disorders of pregnancy. Dr Paz Tayal Clinical Senior Lecturer, NHLI

The research, published in JAMA Cardiology, utilised England’s national primary care database to explore whether there was a link between hypertensive disorders in pregnancy and dilated cardiomyopathy. Over 14,000 individuals with hypertensive disorders during their first pregnancy and over 70,000 individuals without such conditions were included.

The study found that women who experienced hypertensive disorders during their first pregnancy were at twice the long-term risk of developing dilated cardiomyopathy. With this, dilated cardiomyopathy developed on average five years earlier for these women compared to those who had uncomplicated pregnancies.

Dr Paz Tayal, lead author and Clinical Senior Lecturer at the NHLI, said, “This research highlights the importance of considering women-specific risk factors in understanding who is at risk of developing DCM. We need to be vigilant for the development of DCM in women with a history of hypertensive disorders of pregnancy.”

Older maternal age and developing high blood pressure after pregnancy were the major factors that increased the risk of developing dilated cardiomyopathy in women at risk. The authors recommend long-term clinical vigilance of patients with a history of hypertensive disorders during pregnancy. The findings may suggest a shared biological predisposition to both hypertensive disorders of pregnancy and dilated cardiomyopathy, or that hypertensive disorders may contribute to dilated cardiomyopathy through increased subsequent exposure to hypertension over time.

This research builds on Dr Tayal’s previous research on sex differences in dilated cardiomyopathy, which showed that while males are more at risk of developing dilated cardiomyopathy, sex-specific criteria for diagnosis are not being applied, so females are potentially being underdiagnosed.

This research was supported by the MRC and the Royal Society.

Read the paper “Hypertensive Disorders of Pregnancy and Long-Term Risk of Dilated Cardiomyopathy” in JAMA Cardiology.