Hypertensive Disorders in Pregnancy May Double Risk of Dilated Cardiomyopathy Later in Life: Study Reveals

The population-based cohort study conducted in England, published in JAMA Cardiology, found that women with hypertensive disorders of pregnancy had twice the risk of developing dilated cardiomyopathy compared to those without such conditions. The findings emphasize the need for long-term cardiovascular monitoring of women who experience HDP, including conditions such as gestational hypertension and preeclampsia.

Dilated cardiomyopathy is characterized by an enlarged and weakened heart muscle, which can lead to heart failure, arrhythmias, and other serious complications. It often develops silently over time, making early identification particularly important for high-risk groups. Upasana Tayal, National Heart and Lung Institute, Imperial College London, London, United Kingdom, and colleagues aimed to assess the long-term association between hypertensive disorders of pregnancy and the risk of developing dilated cardiomyopathy.

For this purpose, the researchers conducted a population-based cohort study in England using linked electronic health records from the Clinical Practice Research Datalink (CPRD) Pregnancy Register, CPRD Aurum, Hospital Episode Statistics, and Office for National Statistics mortality data. They included 14,083 women who experienced hypertensive disorders during their first pregnancy between January 1997 and December 2018, along with a comparison group of 70,415 women with normotensive pregnancies, randomly selected in a 5:1 ratio. All participants were followed until July 2023. The researchers evaluated the long-term risk of developing dilated cardiomyopathy, using Cox proportional hazards models to estimate hazard ratios.

The following were the key findings of the study:

• The study cohort comprised 14,083 individuals with a hypertensive disorder of pregnancy (HDP) during their first pregnancy and 70,415 individuals with normotensive first pregnancies.
• First pregnancies complicated by HDP were linked to a 93% higher risk of developing dilated cardiomyopathy (DCM) compared to normotensive pregnancies (adjusted HR 1.93; adjusted for maternal age).
• In individuals with HDP, DCM developed a median of 5.1 years postpartum, compared to 10.6 years postpartum in those with normotensive pregnancies.
• The association between HDP and DCM remained significant after adjusting for maternal age, birth year, gestational diabetes, postpregnancy diabetes, post-pregnancy hypertension, total parity, ethnicity, and socioeconomic status (adjusted HR 1.55).
• A dose-response relationship was observed, with higher risks of DCM in those with preeclampsia (adjusted HR 1.85) and severe preeclampsia (adjusted HR 4.29).
• Older maternal age was independently associated with an increased risk of DCM (adjusted HR per year, 1.06).
• Postpartum incident hypertension also emerged as an independent risk factor for DCM (adjusted HR 1.68).

The study showed that hypertensive disorders during pregnancy were linked to a higher long-term risk of developing dilated cardiomyopathy, especially among older mothers and those with postpartum hypertension.

"These findings underline the importance of continued clinical monitoring in women with such pregnancy complications," the authors concluded.

Reference:

Tayal U, Kallis C, Massen GM, Rossberg N, Graul EL, Quint JK. Hypertensive Disorders of Pregnancy and Long-Term Risk of Dilated Cardiomyopathy. JAMA Cardiol. Published online April 02, 2025. doi:10.1001/jamacardio.2025.0328