Risk factors for chronic hypertension 5 years after a pregnancy complicated by preeclampsia: a systematic review and meta-analysis.

Abstract

Approximately 30% of women with a history of preeclampsia develop chronic hypertension within 10 years of pregnancy. This systematic review summarizes risk factors before, during, and immediately after pregnancy for the development of chronic hypertension 5 years after preeclampsia. Databases were searched with terms 'preeclampsia' and 'postpartum hypertension' or 'cardiovascular disease' up to 30th October 2023. Observational studies reporting chronic hypertension more than 5 years after preeclampsia were included. Quality was assessed using the Newcastle-Ottawa scale. Wherever possible, a meta-analysis was conducted. Twenty-one cohort and five case-control studies, with a median quality score of 8/10, were included, involving 197 793 patients and reporting 32 risk factors. Preeclampsia in a subsequent pregnancy is associated with chronic hypertension [risk ratio (RR) 2.26, 95% confidence interval (CI) 1.59-3.22, n = 45 626]. Other significant risk factors include early-onset of preeclampsia (<34 weeks gestation), maternal BMI, blood pressure, diabetes, and family history of hypertension.