Hypertensive disorders of pregnancy and cardiovascular disease risk across races and ethnicities, a review

Pregnancy complications including hypertensive disorders of pregnancy (HDP) can be the first indicator of increased risk of cardiovascular disease (CVD). Despite the importance of addressing racial and ethnic differences in the incidence of CVD, most research on the role of HDP is conducted in white majority populations. In this review, we present an overview of the evidence on racial and ethnic differences in the occurrence of HDP, as well as on the association of HDP with cardiovascular risk factors and CVD across different non-White populations. We conducted a systematic literature review to identify all relevant studies. We systematically searched PubMed and Embase from inception to February 2022. We included 53 articles that reported on HDP prevalence and 62 articles that reported on CVD risk after HDP. Compared to non-Hispanic White women (NHW), prevalence of preeclampsia (PE), but not gestational hypertension (GH), seemed increased among non-Hispanic Black (NHB) women in the US and women from Sub-Saharan African origin in Europe (Figure 1). PE prevalence was higher among Hispanic US women than among NHW women. Women from East Asian, Southeast Asian, North African or Middle Eastern origin seemed at decreased risk for HDP compared to NHW women. The association between HDP and CVD was fairly consistent among different racial and ethnic groups (Figure 2). Only three studies formally tested potential interaction between HDP and race for CVD risk; results were contradictory. This review highlights that there are racial and ethnic differences in the prevalence of all types of HDP. HDP is associated consistently with increased CVD risk across racial and ethnic groups, but further studies on potential differences and their etiology is required. Guidelines should be updated and based on evidence from more racially and ethnically diverse study populations, allowing better monitoring strategies and timely interventions, aiming to reduce the unequal burden of HDP and CVD across races and ethnicities.View Large Image Figure ViewerDownload Hi-res image Download (PPT)