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\begin{document}

\title{Do we also need recommendations on management of hypertension rise?}



\author[1]{Miriam van Oostwaard}%
\affil[1]{IJsselland Ziekenhuis}%


\vspace{-1em}



  
  \date{May 25, 2024}


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\emph{Title page}

\emph{Title}

Do we also need recommendations on management of hypertension rise?

Mini commentary for

Wen T et al. Trends and Outcomes for Deliveries with Hypertensive
Disorders of Pregnancy from 2000 to 2018: A Cross-Sectional Study
(Manuscript ID BJOG-21-1382.R1)

\emph{Corresponding author}

Miriam F. van Oostwaard, MD, PhD

Bremstraat 15

3053DC Rotterdam

The Netherlands

Affiliation:

IJsselland Ziekenhuis

Prins Constantijnweg 2

2906 ZC Capelle aan den IJssel

The Netherlands

miriamvanoostwaard@gmail.com

+31-6-16432022

\emph{Disclosure of Interests}

No funding was received for the creation of this mini commentary.

\emph{Contribution to Authorship}

MvO did all the writing of this mini commentary

\emph{Details of Ethics Approval}

Not applicable to mini commentaries

Do we also need recommendations on management of hypertension rise?

So good to read an article that is well written and reports of a
well-numbered registry based study. So much information can be derived
from the registries. This study was aimed to report on trends of
incidence and outcome of hypertensive disorders of pregnancy (HDP); risk
factors and outcome, an information-gap after the implementation of new
recommendations by the American College of Obstetricians and
Gynecologists (ACOG) in 2013. {[}ACOG task force, Obstet Gynecol 2013,
122(5):1122-1131{]}. The recommendations involve diagnosis, prevention,
monitoring and management, aiming to improve maternal and neonatal
outcome. Now would be a good time to check if they do. Unfortunately,
risk factors for HDP or adverse outcome, such as obesity and chronic
hypertension also seem to rise.

The authors report 5.6 million women (7.7\%) with a diagnoses of HDP in
73.1 million delivery hospitalizations from 2000 to 2018. The proportion
of HDP almost doubled from 603 to 1,196 per 10,000 delivery
hospitalizations, representing an average annual percent change (AAPC)
of 3.8\% (95\% CI 3.4\%, 4.2\%) over the study period. Severe HDP
demonstrated the largest increases. In the same period, risk factors for
HDP increased from 9.6\% to 24.6\%. This seems to account for part of
the increase in incidence of HDP. The incidence of stroke decreased
significantly for women with HDP, but only after 2013, suggesting an
effect from the new recommendations. In contrast, incidences of acute
renal failure and acute liver injury increased, comparable to the
incidences in non-hypertensive pregnancies.

Writing this commentary, my thoughts go out to all the caregivers that
fill in the extensive lists of items, day in, day out, after every
delivery. Without their work, none of the data would exist, and without
their accuracy, none of the data would be reliable. Registries are ideal
for trend-analyses on a population wide scale, but let's not forget
where they're limitations. Interpretations and Misclassifications occur.
New recommendations may create awareness and focus on these diagnoses.
Validation trials reveal good quality of hospital databases, but
diagnoses and birth data are generally less accurate than for most
conditions and procedures {[}Lain et al. Med Care, 2012, 50(4),
e7-20{]}. Using delivery hospitalizations should rule out duplications
(recurrent hospitalizations appear as distinct observations {[}Khera et
al Circulation 2017, 10(7), e003846{]}, but may also rule out postpartum
HDP, or stroke.

Still, considering all of the above, the numbers are alarming. Where is
this going? How many more HPD are we going to face in the coming period?
What can we do to prevent this from escalating? What will be the effect
of aspirin, which we are more and more prescribing, in a population that
holds more and more risk-factors for HDP. We cannot emphasize enough on
prevention. We may need new recommendations to address the rising
prevalence of obesity, renal failure and liver injury (with or without
HDP).

Last but not least, I find it appreciating to conclude that management
modifications do have a positive effect on the incidence of stroke.

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