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 patients with hypertension. In women with prior HDP and PA risk factors, we examined PA prevalence and its relationship to hypertension trajectory.

Adults across the US 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±9.8 years; 32.1% non-White), 83 (25.2%) reported a history of HDP. Women with HDP were younger at hypertension diagnosis (38.8 versus 47.9 years; P<0.001). The prevalence of a positive PA test was similarly high in those with and without HDP (26.5% versus 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% versus 60.9%; P=0.11) and fetal complications (55.6% versus 27.9%; P<0.01). Hypertension trajectories also differed: sustained hypertension persisting beyond the postpartum period was nearly twice as frequent in women testing positive for PA (66.7 versus 37.5%; P=0.047).

Over 25% of women with hypertension, ≥1 PA risk factor, and prior pregnancy tested positive for PA, highlighting its high prevalence, irrespective of a history of HDP. Women with HDP face elevated cardiovascular risk, and PA may represent a targetable contributor.