Hypertensive Disorders of Pregnancy and Primary Aldosteronism

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.

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.

Of 330 hypertensive parous women (62.4 ± 9.8y; 32.1% non-white), 83 (25.2%) reported a history of HDP. Women with HDP were younger at hypertension diagnosis (38.8 vs. 47.9y; p <0.001). The prevalence of a positive PA test was similarly high in those with and without HDP (26.5% vs 32%; p = 0.35). 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).

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.