Does primary aldosteronism associate with sustained hypertension and fetal complications in women with prior hypertensive disorders of pregnancy?
Primary aldosteronism is prevalent among women with prior hypertensive disorders of pregnancy and is associated with sustained hypertension and higher rates of fetal complications.
Background: Hypertensive disorders of pregnancy (HDP) affect up to 15% of pregnancies and are linked to adverse maternal and fetal outcomes. Primary aldosteronism (PA) affects up to 25% of hypertensive patients. We examined PA prevalence in women with prior HDP and its relationship to hypertension trajectory. Methods: Adults from across the U.S.A. meeting guideline-recommended screening criteria for PA were prospectively tested. Women with a self-reported history of HDP completed a questionnaire examining the relationship between PA and hypertension trajectory. Results: ). Among women with HDP, 63 completed the follow-up questionnaire, of whom 15 (23.8%) tested positive for PA. Compared with PA-negative women, those with PA reported a higher proportion of pregnancies complicated by hypertension (76.5% vs. 60.9%, p = 0.11) and fetal complications (55.6% vs. 27.9%, p <0.01). Hypertension trajectories also differed: sustained hypertension, defined as persistently elevated blood pressure beyond the postpartum period, was nearly twice as frequent in women with a positive PA test (66.7 vs. 37.5%; p=0.047). Conclusion: Over 25% of women with hypertension and a prior pregnancy screened positive for PA, highlighting its high prevalence, irrespective of history of HDP. Women with HDP remain at elevated cardiovascular risk, and PA may represent a targetable contributor.
Salle et al. (Fri,) studied this question.