Cardiovascular and Renal Outcomes in Preeclampsia

Preeclampsia, a hypertensive syndrome unique to pregnancy, triggers widespread endothelial injury that may leave lasting imprints on both heart and kidney. During the affected gestation, anti-angiogenic factors and heightened vascular resistance can provoke left ventricular thickening, diastolic filling impairments and glomerular endothelial damage manifesting as proteinuria. Although blood pressure often returns to normal postpartum, women with a history of preeclampsia exhibit persistent subclinical diastolic dysfunction, increased arterial stiffness and ongoing renal impairment. Longitudinal studies report a near doubling of chronic kidney disease incidence and, in severe or recurrent cases, as much as a fivefold rise in end-stage kidney disease risk. Early-onset and preterm presentations portend the greatest long-term burden. These insights underscore the importance of structured cardiovascular evaluation and renal surveillance to pre-empt progression of organ damage in this vulnerable population.

Research from Nature Portfolio

A retrospective echocardiographic analysis of mid-gestation pregnancies has established maternal age as a critical determinant of diastolic performance. Women aged over 32 years showed a significantly higher prevalence of reduced mitral annular velocity, indicating impaired ventricular relaxation. Importantly, those with early diastolic dysfunction faced a markedly increased likelihood of developing preeclampsia later in pregnancy, suggesting that early screening of cardiac filling dynamics may help identify women at elevated risk of hypertensive complications.

Cardiovascular and Renal Outcomes in Preeclampsia publication trend

The graph below shows the total number of articles in cardiovascular and renal outcomes in preeclampsia across all publications each year (not limited to Nature Index journals).

Technical terms

Preeclampsia: A pregnancy-specific disorder marked by new-onset hypertension after 20 weeks’ gestation and signs of organ dysfunction.

Diastolic dysfunction: Impaired relaxation of the left ventricle during the heart’s filling phase.

Endothelial dysfunction: A state in which the vascular lining loses its normal vasodilatory and anti-thrombotic properties.

Proteinuria: The excretion of excess protein in the urine, reflecting damage to the kidney’s filtration barrier.

Chronic kidney disease (CKD): Persistent reduction in kidney function or markers of kidney damage lasting more than three months.

End-stage kidney disease (ESKD): The final stage of kidney failure requiring dialysis or transplantation.

References

1. Temporal patterns of pre- and post-natal target organ damage associated with hypertensive pregnancy: a systematic review. European Journal of Preventive Cardiology (2023).
2. Preeclampsia and risk of end stage kidney disease: A Swedish nationwide cohort study. PLOS Medicine (2019).
3. Hypertensive disorders of pregnancy and the risk of chronic kidney disease: A Swedish registry-based cohort study. PLOS Medicine (2020).
4. Hypertensive disorders of pregnant women with heart disease: the ESC EORP ROPAC Registry. European Heart Journal (2022).
5. The correlation between maternal age, parity, cardiac diastolic function and occurrence rate of pre-eclampsia. Scientific Reports (2021).