May 17 is Hypertension Awareness Day, and awareness is a much-needed and appropriate goal for this condition. Nearly half of the adults in the United States experience hypertension, yet many still associate the condition with old age and don’t seriously consider their own risk.
The lack of knowledge about hypertension — its risks, prevalence, and complications — is a major problem for women of reproductive age. Hypertension is one of the leading causes of maternal mortality, yet until recently, it was generally believed that pregnant women are only at risk for developing hypertension as they age.
These women — so-termed “geriatric pregnancies” — are immediately considered high risk and as such tend to be better informed about potential complications. But this level of awareness needs to extend beyond high risk pregnancies — beyond the pregnancy period itself.
Recent studies show that Gen-Z women are now twice as likely to develop hypertension in pregnancy than their mothers, even after taking age into account, and the root causes can be present long before conception. Chronic hypertension in women of reproductive age has doubled in the last ten years, affecting 13-30% of women, and catching it early is critical to improving outcomes.
Think of it like this: a woman gets pregnant not knowing that she suffers from high blood pressure. She writes off potential red flags like headaches and muscle pain as normal symptoms of pregnancy — as many of the warning signs of gestational hypertension are — and then at 29 weeks she finds herself rushing to the hospital with preeclampsia, for which the only solution is an early delivery of her not yet full-term pregnancy. Her baby spends weeks in the NICU while she (perhaps unknowingly) is now at much higher risk of developing cardiovascular issues down the road.
Instead, imagine that she is aware of her potential for risk and, as she is considering getting pregnant, brings it up to her primary care provider. She is diagnosed with chronic hypertension and her doctor recommends a specific diet and exercise regimen, as well as instructions to monitor her blood pressure from home. Now when that woman becomes pregnant, she’s already developed good habits around blood pressure management and is educated about her risk. Under these circumstances, that woman is now four times less likely to develop a more serious blood pressure-related condition like preeclampsia.
She’s also prepared to keep track of her blood pressure after childbirth, a time when risks to a mother’s health are much higher but care drops off significantly. And these risks endure beyond the 42 days that are traditionally considered the “postpartum” period.
Women with hypertensive disorders of pregnancy have seven times the risk of developing chronic hypertension in the two years following childbirth. They’re also three times as likely to experience heart failure in that time frame. These risks alone are reason enough to extend the duration of blood pressure monitoring beyond the typical postpartum period.
And monitoring should not be confined to women with chronic hypertension or women that have already experienced pregnancy-induced hypertension. One in 10 women who develop hypertension as a result of pregnancy might not experience it until more than six weeks after childbirth, the typical end of standard postpartum care.
We’ve been used to thinking of maternity care in very limited terms, and we need to change that approach to consider it more holistically. A healthy pregnancy starts before conception, and continues long past childbirth. Hypertension awareness and management should be a standard part of women's healthcare.