Are Hypertensive Disorders of Pregnancy Associated With Structural Heart Changes?

Women with a history of hypertensive disorders of pregnancy may have major differences in the structure and function of the heart a decade after pregnancy vs. women whose blood pressure during pregnancy was normal, according to a study published Feb. 22 in the Journal of the American College of Cardiology.

Malamo Countouris, MD, et al., looked at 132 women with pregnancies delivered from 2008 to 2009, who underwent transthoracic echocardiography eight to 10 years after delivery (2017 to 2020). Of the group, 102 had normotensive pregnancies, while 30 had hypertensive disorders of pregnancy. Within the hypertensive disorders of pregnancy group, 21 had preeclampsia and 9 had gestational hypertension.

Results showed that compare with women with normotensive pregnancies, those with hypertensive disorders of pregnancy were more likely to have current hypertension (63% vs. 26%; p<0.001). In addition, after adjusting for age, race, MVM lesions, body mass index, current hypertension, and hemoglobin A1c, women with a history of hypertensive disorders of pregnancy had higher interventricular septal thickness and relative wall thickness.

In subgroup analyses, 79% of women with both history of hypertensive disorders of pregnancy and current hypertension had left ventricular remodeling. Further, having both a history of hypertensive disorder of pregnancy and current hypertension was also associated with abnormal diastolic function parameters, suggesting a “’double-hit’ phenomenon” and “warranting closer surveillance and early and targeted therapies for [cardiovascular disease] prevention in this higher-risk group.”

“Identifying women at high risk can provide a window of opportunity for targeted interventions to prevent cardiovascular disease,” said Countouris. “Suggesting simple changes in lifestyle or diet, including regular exercise and better management of other cardiovascular risk factors, can prevent adverse changes in the heart and lower the risk of cardiovascular disease later in life.”

In a related editorial comment, Melinda B. Davis, MD, FACC, adds that moving forward, “Future research is needed to better understand the pathophysiologic mechanisms and the optimal delivery of care; in parallel, we need to rigorously diagnose and treat hypertension and other [cardiovascular disease] risk factors in young women with prior [hypertensive disorders of pregnancy].”

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Vascular Medicine, Echocardiography/Ultrasound, Diet, Hypertension

Keywords: Hypertension, Pregnancy-Induced, Hemoglobin A, Blood Pressure, Eclampsia, Body Mass Index, Ventricular Remodeling, Risk Factors, Blood Pressure Determination, Diet, Cardiovascular System, Echocardiography

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