Cor Vasa 2026, 68(5):562-568 | DOI: 10.33678/cor.2026.006

Chronic Hypertension as a Risk Factor for Peripartum Cardiomyopathy (PPCM): Insights from a Case-Control Study in Indonesia

Witri Pratiwia, b, Yogi Puji Rachmawanc, Asri C. Adisasmitaa, Sudarto Ronoatmodjoa, Amiliana Mardiani Soesantod
a Department of Epidemiology, Faculty of Public Health, University of Indonesia, Depok, Indonesia
b Department of Community Medicine and Public Health, Faculty of Medicine, Universitas Swadaya Gunung Jati, Cirebon, Indonesia
c Department of Cardiovascular Medicine, Faculty of Medicine, Universitas Swadaya Gunung Jati, Cirebon, Indonesia
d Department of Cardiology and Vascular Medicine, Faculty of Medicine, Harapan Kita National Cardiovascular Centre, Jakarta, Indonesia

Background: Peripartum cardiomyopathy (PPCM) is a rare but serious cause of maternal heart failure. Hypertension is a major contributing factor of PPCM, but evidence from Indonesia remains limited.

Objective: This study examined the association between chronic hypertension and PPCM in two referral hospitals in Cirebon, West Java, from 2019 to 2024.

Method: A case-control design included 84 women diagnosed with PPCM according to the European Society of Cardiology (ESC) criteria and 336 controls without PPCM. Frequency matching based on hospital was conducted. Multivariable unconditional logistic regression was performed to assess the independent risk of chronic hypertension for PPCM.

Results: Chronic hypertension showed a strong association with PPCM (cOR 22.2; 95% CI 6.21-79.31), which remained significant after adjusting for maternal age, pre-pregnancy obesity and hospital (aOR 17,13; 95% CI 3,71-79,14). In conclusion, chronic hypertension is an independent risk factor for PPCM.

Conclusion: These findings highlight the importance of cardiovascular risk assessment and optimal blood pressure control in women with chronic hypertension to reduce PPCM risk and improve maternal outcomes.

Keywords: Chronic hypertension, Maternal health, Peripartum cardiomyopathy, Pregnancy

Received: November 16, 2025; Revised: January 4, 2026; Accepted: January 20, 2026; Prepublished online: October 12, 2026; Published: October 20, 2026  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Pratiwi W, Rachmawan YP, Adisasmita AC, Ronoatmodjo S, Soesanto AM. Chronic Hypertension as a Risk Factor for Peripartum Cardiomyopathy (PPCM): Insights from a Case-Control Study in Indonesia. Cor Vasa. 2026;68(5):562-568. doi: 10.33678/cor.2026.006.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Ardissino M, Halliday BP, De Marvao A. The Global Landscape of Peripartum Cardiomyopathy: Morbidity, Mortality, Recovery and Inequity. Eur J Heart Fail 2024;26:43-45. Go to original source...
    2. Arany Z. Peripartum Cardiomyopathy. Leopold JA, editor. N Engl J Med 2024;390:154-164. Go to original source...
    3. Schaefer V, Hilfiker-Kleiner D, Keil C. Hypertension in Pregnancy. Cardiovasc Med 2023;26:80-86. Go to original source...
    4. Wang X, Zheng K, Zhang Q. Risk Factors for Peripartum Cardiomyopathy: A Systematic Review and Meta-Analysis. Heart Lung Circ 2025;34:e125-e133. Go to original source...
    5. Octaria Y, Khomsan A, Tanziha I, Sukandar D. Prevalence and Determinants for Hypertension among Rural Women of Reproductive Age in Indonesia. Jurnal Gizi dan Pangan. 2020;15:71-80. Go to original source...
    6. Vohra JG, Pathania A, Vohra P, et al. Prevalence of Metabolic Disorders Among Women in Reproductive Age Group in Hilly Rural Area of North India. J Family Med Prim Care 2024;13:579-584. Go to original source...
    7. Mohebi A, Pathirana M, Khoja A, et al. Prevalence of Metabolic Syndrome Among Pregnant Women: A Systematic Review and Meta-Analysis. Endocrine 2025;88:398-409. Go to original source...
    8. Seely EW, Ecker J. Chronic Hypertension in Pregnancy. Circulation 2014;129:1254-1261. Go to original source...
    9. Richard KL, Benjamin PK. Hypertension in Pregnancy. In StatPearls Publishing; 2025. Online. Available from: https:// www.ncbi.nlm.nih.gov/books/NBK430839/. [cited 2025-10-21].
    10. Jackson AM, Petrie MC, Frogoudaki A, et al. Hypertensive Disorders in Women with Peripartum Cardiomyopathy: Insights from the ESC EORP PPCM Registry. Eur J Heart Fail 2021;23:2058-2069. Go to original source...
    11. Arfianda D, Wicaksono B, Gumilar KE, Andrianto A. Characteristics of Peripartum Cardiomyopathy (PPCM) Pregnancy and Preeclampsia in Dr Soetomo Hospital, Surabaya, Indonesia, 2014-2016. Majalah Obstetri & Ginekologi 2019;27:40. Go to original source...
    12. Prameswari HS, Purnomowati A, Aprami TM. Prevalence, 1 Characteristics, and Risk Factor of Patient with Peripartum Cardiomyopathyin Hasan Sadikin Hospital Bandung. Indonesian Journal of Cardiology 2016;36:38-44. 1 Go to original source...
    13. De Backer J, Haugaa KH, Hasselberg NE, et al. 2025 ESC Guidelines for the Management of Cardiovascular Disease and Pregnancy. Eur Heart J 2025;46:4462-4568. 2 Go to original source...
    14. Huang W, Syahruddin SS, Johansyah AA, et al. Association of Hypertensive Disorders of Pregnancy and their Clinical Features with Peripartum Cardiomyopathy: A Systematic Review and 2 Meta-analysis. Curr Cardiol Rev 2025;21:1-12. Go to original source...
    15. Ferreira AF, Azevedo MJ, Saraiva FA, et al. The PERInatal MYocardial Remodeling (PERIMYR) Cohort Study Protocol: 2 A Prospective Study of Cardiac Remodeling and "Recovery" in Pregnancy as a Model to Understand the Impact of Comorbidities in Cardiac Remodeling and Reverse Remodeling. Rev Port Cardiol 2023;42:585-596. 2 Go to original source...
    16. Di Martino DD, Stampalija T, Zullino S, et al. Maternal Hemodynamic Profile During Pregnancy and in the Post-Partum in Hypertensive Disorders of Pregnancy and Fetal Growth Restriction. Am J Obstet Gynecol MFM. 2023;5:1-10. 2 Go to original source...
    17. Sigauke FR, Ntsinjana H, Tsabedze N. Peripartum Cardiomyopathy: A Comprehensive and Contemporary Review. Heart Fail Rev 2024;29:1261-1278. Go to original source...
    18. Wooldridge AL, Chan C, Spaans F, et al. Increased Stiffness of Omental Arteries from Late Pregnant Women at Advanced Maternal Age. Bioscience Reports 2023;43:1-8. Go to original source...
    19. Patel D, Avesani M, Johnson MR, et al. Maternal Cardiovascular Adaptation to Pregnancy in Obese Pregnant Women. Acta Obstet Gynecol Scand 2024;103:907-916. Go to original source...
    20. Echouffo-Tcheugui JB, Guan J, Retnakaran R, Shah BR. Gestational Diabetes and Incident Heart Failure: A Cohort Study. Diabetes Care 2021;44:2346-2352. Go to original source...
    21. Cho SH, Leonard SA, Lyndon A, et al. Pre-pregnancy Obesity and the Risk of Peripartum Cardiomyopathy. Am J Perinatol 2021;38:1289-1296. Go to original source...
    22. Putra ICS, Irianto CB, Raffaello WM, et al. Pre-pregnancy obesity and the risk of peripartum cardiomyopathy: A systematic review and meta-analysis. Indian Heart J 2022;74:235-238. Go to original source...
    23. Lopez-Yañez Blanco A, Díaz-López KM, Vilchis-Gil J, et al. Diet and Maternal Obesity Are Associated with Increased Oxidative Stress in Newborns: A Cross-Sectional Study. Nutrients 2022;14:746. Go to original source...
    24. Khan SS, Petito LC, Huang X, et al. Body Mass Index, Adverse Pregnancy Outcomes, and Cardiovascular Disease Risk. Circ Res 2023;133:725-735. Go to original source...

    This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0), which permits non-comercial use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content