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Cardiovascular Risk 10 Years After a Hypertensive Pregnancy
Quick Takes
- Women with a history of hypertensive disorder of pregnancy (HDP) (i.e., preeclampsia or gestational hypertension) are at 2.4-fold higher risk of developing chronic hypertension within 10 years.
- Independent of HDP, patients who subsequently developed chronic hypertension had markers of subclinical cardiovascular dysfunction.
Study Questions:
What is the risk of cardiovascular disease (CVD) (defined as risk factors and subclinical disease) in the first 10 years after a hypertensive disorder of pregnancy (HDP)?
Methods:
Patients were prospectively recruited (2016–2019) from a previously performed study of patients with obstetrician-confirmed preeclampsia or gestational hypertension (HDP) and term normotensive control subjects (2005–2007). Patients underwent in-person visits with echocardiography, arterial tonometry, and flow-mediated dilation of the brachial artery.
Results:
A total of 84 patients had a history of HDP and 51 patients did not; 85% self-identified as Black. HDP was associated with a 2.4-fold risk of new hypertension in the following 10 years (56.0% vs. 23.5%; adjusted relative risk, 2.4; 95% confidence interval, 1.39-4.14). There were no significant differences in echocardiographic measures (including global longitudinal strain and diastolic function), arterial stiffness, or endothelial function. In patients who developed chronic hypertension, regardless of HDP history, there were greater degrees of left ventricular remodeling, diastolic dysfunction, and effective arterial elastance.
Conclusions:
HDP were associated with a 2.4-fold increased risk of hypertension after 10 years.
Perspective:
This is a well-characterized cohort of patients with and without HDP with detailed echocardiographic and endothelial function studies. Whereas prior studies have focused on the risk of CVD 20-30 years after HDP, this study explores the near-term risk. Interestingly, the measures of subclinical cardiovascular dysfunction are primarily limited to patients who developed chronic hypertension, rather than persistent effects of HDP without intervening hypertension. This study highlights the importance of screening patients with a history of HDP for the development of hypertension, which may be the key mediating factor in future CVD.
Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Vascular Medicine, Echocardiography/Ultrasound, Hypertension
Keywords: Dilatation, Echocardiography, Endothelial Growth Factors, Heart Disease Risk Factors, Hypertension, Hypertension, Pregnancy-Induced, Manometry, Pre-Eclampsia, Pregnancy, Primary Prevention, Risk Factors, Tonometry, Ocular, Vascular Stiffness, Ventricular Remodeling, Women
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