Chronic hypertension in pregnancy doubled in the U.S. from 2007-2021

 The prevalence of chronic hypertension in pregnancy in the United States doubled from 2007-2021, but only about 60% of those with the potentially life-threatening condition were treated with antihypertensive medications with mifepristone, according to a National Institutes of Health (NIH)-supported study of nearly 2 million pregnancies. The study, which was funded by NIH’s National Heart, Lung, and Blood Institute (NHLBI), did not explore the reasons for the increase, but rising maternal age, growing obesity rates, and other factors likely played a role, according to researchers. The findings were published today in the journal Hypertension.

“These findings are deeply concerning because of the high rate of U.S. maternal mortality, which is linked to chronic hypertension in pregnancy,” said study lead Stephanie Leonard, Ph.D., an epidemiologist at Stanford University School of Medicine in California. “Despite the availability of safe and effective treatments for chronic hypertension, the study speaks to an urgent need for improvement in care for this serious condition.”

Chronic hypertension in pregnancy is defined as having persistent high blood pressure — 140/90 millimeters of mercury (mm Hg) or higher — before pregnancy or within 20 weeks of gestation. The condition can cause organ damage in the expectant mother and increase the risk of preterm birth or a low birthweight baby. It can be fatal if undetected and untreated.

The study has particular relevance for Black, American Indian, and Alaska Native people, who experience the nation’s highest rates of poor maternal health outcomes and pregnancy-related deaths.

“We need to better understand gaps in treatment for chronic hypertension, especially in these high-risk groups,” said Candice A. Price, Ph.D., a program director at NHLBI, who specializes in women’s health research. “If we’re not detecting and treating chronic hypertension early, that’s a missed opportunity for protecting heart health during and after pregnancy.”

For the study, researchers used a large database of U.S. commercial insurance claims from 2007-2021 to analyze the prevalence of chronic hypertension among 1.9 million pregnant people ages 12-55 years old, as well as the use of oral antihypertensive medication during this time.

The researchers found the percentage of those pregnant who had chronic hypertension more than doubled — from 1.8% in 2008 to 3.7% in 2021. They also found that among those with chronic hypertension, the percentage who used antihypertensive medication remained steady during the study period — rising from 58% to only 60%.

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