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American Heart Association blood pressure classification and subsequent risk of preeclampsia

Rebecca Horgan1, Erkan Kalafat2, Elena Sinkovskaya1

  • 1Macon & Joan Brock Virginia Health Sciences Old Dominion University Norfolk Virginia USA.

Pregnancy (Hoboken, N.J.)
|August 14, 2026
PubMed

Insights

The American Heart Association (AHA) hypertension guidelines applied in early pregnancy identified increased risks for hypertensive disorders of pregnancy (HDPs). This approach offers earlier risk stratification than current standards, aiding personalized care.

Area of Science:

  • Obstetrics and Gynecology
  • Cardiology
  • Public Health

Background:

  • The 2017 American Heart Association (AHA) and American College of Cardiology hypertension guidelines lowered diagnostic thresholds to ≥130/80 mmHg.
  • This update prompted investigation into whether previously normal pregnancy blood pressure (BP) levels pose an increased risk for hypertensive disorders of pregnancy (HDPs).

Purpose of the Study:

  • To assess the association between first-trimester BP, categorized by AHA thresholds, and the development of HDPs.
  • To compare the predictive performance of AHA guidelines versus American College of Obstetricians and Gynecologists (ACOG) thresholds for HDPs.

Main Methods:

  • A secondary analysis of a prospective, multicenter cohort study included singleton pregnancies at ≤13 6/7 weeks' gestation, excluding those with pre-existing hypertension.
  • First-trimester BP was classified using AHA categories: normal (<120/80 mmHg), elevated (120-129/<80 mmHg), Stage 1 (130-139/80-89 mmHg), and Stage 2 (≥140/90 mmHg).
  • Multivariable Cox regression and concordance indices were used to evaluate associations and predictive performance for preeclampsia, gestational hypertension, and HDPs.

Main Results:

  • Among 576 participants, 13.0% developed HDP, with 7.6% having preeclampsia.
  • Preeclampsia incidence increased with AHA BP categories: 4.8% (normal), 11.2% (elevated), 14.6% (Stage 1), and 16.7% (Stage 2) (p < 0.001).
  • AHA-based models demonstrated superior prediction of HDP compared to ACOG thresholds (C-index, 0.71 vs. 0.65; p < 0.05).

Conclusions:

  • First-trimester BP classification using AHA guidelines provides a more refined method for stratifying HDP risk in pregnancy.
  • This approach allows for earlier identification of at-risk individuals beyond the current ACOG definition of chronic hypertension in pregnancy.
  • Utilizing AHA guidelines supports more personalized counseling and the implementation of preventive strategies for HDPs.
Abstract

Keywords:
American Heart Associationblood pressurepreeclampsia

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