Page 23 - RU Robert Wood Johnson Medicine • Summer 2020

also showed some association with trends in chronic hypertension, although cohort effects were less evident when compared with the other two factors. When they looked at birth cohort, Dr. Ananth and his team saw an increased risk of hypertension for women born after 1980—when average body weights started to increase in the United States—and those born between 1920 and 1940, when smoking was popular.
“A woman who gives birth at age 20 in 1970 and one who gives birth at 20 in 2010 is the same age when they deliver—but they’re born 40 years apart. We wanted to see if women born in certain decades were predisposed to certain conditions, which we now know they are,” Dr. Ananth says. One reason the rate of chronic hypertension is increasing is that some of the risk factors associated with chronic hypertension—pregestational diabetes,
overweight or obesity, metabolic syndrome, and pregnancy with multiples—are on the upswing. Another is that women are choosing to start their families later, which increases the risk of developing chronic hypertension. Since 1970, the mean age at first delivery has increased by five years, which is bound to have a strong impact on these trends.
The Role of Race
While the prevalence of chronic hypertension is increasing in the United States, so is the racial disparity.
The study found that Black women developed chronic hypertension at twice the rate of white women in any given year. Dr. Ananth attributes this to the “heavier history of risk” that this population carries, related to body-mass index, socioeconomic status, prevalence of tobacco and drug use, levels of stress, reduced access to care, insufficient or lack of medical insurance, and of course genetic factors.
The researchers also theorize that the imbal- ance exists because Black women endure higher rates of hypertension-related complications like preeclampsia, pregestational and gestational diabetes, preterm delivery, and perinatal mortality.
The Implications for Patients and Providers
Chronic hypertension also increases patients’ risk of developing more serious conditions. In fact, women with chronic hypertension have a
six- to eightfold higher chance of cardiovascular complications, including acute myocardial infarc- tion and heart failure, according to Dr. Ananth.
“Because the study found that the biggest contributors of hypertension are age and time period—factors that will never change—the question now becomes, how can individuals lessen the growing burden of chronic hypertension, and subsequently lower the adverse outcomes in pregnancy?” he adds.
The optimal age to have a baby in the United States is between 25 and 29 years old, says Dr. Ananth, when the risk of complications is lowest.
Chronic hypertension also increases patients risk of developing
more serious conditions. In fact, women with chronic hypertension have a six– to eightfold chance of cardiovascular complications, including acute myocardial infarction and heart failure, according to
Dr. Ananth.
“Many women have high blood pressure prior to pregnancy, so I wanted to see how elevated blood pressure early in pregnancy affects
the mother and baby,” says Cande V. Ananth, PhD, MPH.
Cande V. Ananth, PhD, MPH
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