A 46-year-old woman with a history of pre-eclampsia is referred to the clinic as part of a cardiovascular risk stratification for pre-employment screening.
Her examination findings are notable for blood pressure (BP) 137/89 mm Hg, heart rate 82 bpm, no jugular venous distention, regular heart rhythm with an S4 gallop, clear lungs, and no lower extremity edema. An echocardiogram demonstrates mild concentric left ventricular hypertrophy (1.3 cm), end-diastolic dimension 4.8 cm, unremarkable valves, and ejection fraction estimated at 57% by biplane.
She is concerned about developing heart failure (HF) and wants to know her present risk of HF.
The patient is considered to be at risk of HF at present.
Show Answer
The correct answer is: Fact
Elevated systolic and diastolic BP are major risk factors for the development of symptomatic HF. A treatment goal of <130/80 mm Hg is recommended for those with a cardiovascular disease risk of ≥10%.1-3 Although the magnitude of benefit varies with the patient population, target BP reduction, and HF criteria, effective hypertension treatment invariably reduces HF events. Therefore, the 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America (AHA/ACC/HFSA) Guideline for the Management of HF recommends optimal control of BP in patients with hypertension as a Class 1 indication.1
In addition, patients with hypertensive disorders of pregnancy (HDP), including pre-eclampsia, are known to experience increased HF risk compared with women without HDP.4,5 To this end, a contemporary cohort study including 508,422 women in Norway found nearly a twofold risk of incident HF in women with a history of pre-eclampsia.4
Educational grant support provided by: Boehringer Ingelheim Pharmaceuticals Inc. (BIPI) and Lilly USA, LLC (Lilly). To visit the course page for the Heart Failure & SGLT2is: The New Pillar in Care grant, click here!
References
Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. J Am Coll Cardiol 2022;79:e263-e421.
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol 2018;71:e127-e248.
Khan SS, Ning H, Shah SJ, et al. 10-year risk equations for incident heart failure in the general population. J Am Coll Cardiol 2019;73:2388-97.
Honigberg MC, Riise HKR, Daltveit AK, et al. Heart failure in women with hypertensive disorders of pregnancy: insights from the cardiovascular disease in Norway project. Hypertension 2020;76:1506-13.
Blumer V, Pagidipati NJ. Hypertensive disorders of pregnancy and long-term heart failure risk: a missed opportunity for prevention. Hypertension 2020;76:1420-22.
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