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Risk Assessment After Hypertensive Pregnancy
Quick Takes
- Women with hypertensive disorders of pregnancy are at increased risk for chronic hypertension.
- Maternal characteristics and echocardiographic data may identify women at higher risk of chronic hypertension after a pregnancy complicated by hypertension.
Study Questions:
What are effective screening measures for predicting chronic hypertension (cHTN) in women with hypertensive disorders of pregnancy (HDP)?
Methods:
Women with HDP were prospectively enrolled and had an echocardiogram performed during pregnancy or up to 1 week after delivery. At postpartum follow-up (3-12 months postpartum), they were evaluated for cHTN (defined as blood pressure ≥140/90 mm Hg or on antihypertensive medications). Predictive models for cHTN were developed from univariate and multivariate analyses of clinical and echocardiographic data.
Results:
The median (interquartile range) follow-up time after delivery was 124 (103-145) days, at which time 70 of 211 (33%) women were diagnosed with cHTN. Women were more likely to develop cHTN if they were older (35.5 ± 5 vs. 32.9 ± 5.6 years, p = 0.001), of Afro-Caribbean descent (27.1 vs. 7.8%, p < 0.0001), had higher body mass index (33.4 ± 5.9 vs. 31.2 ± 5.4 kg/m2, p = 0.006), and higher mean arterial pressure (106.5 ± 8.4 vs. 103.3 ± 7.0 mm Hg, p = 0.004). Peripartum echocardiographic findings associated with cHTN were: higher left ventricular mass index (84 ± 17.9 vs. 76.3 ± 14.8 g/m2, p = 0.001), higher relative wall thickness (0.46 ± 0.1 vs. 0.40 ± 0.1, p < 0.0001), and lower global longitudinal strain (-15.6 ± 2.7 vs. -16.6 ± 2.2%, p = 0.006). The authors created a prediction model using maternal age, first trimester blood pressure, and echocardiographic data (left ventricular mass index >75 g/m2, relative wall thickness >0.42, and E/E’ >7). This model predicted cHTN after HDP with an area under the curve of 0.85 (95% confidence interval, 0.79-0.90).
Conclusions:
The authors concluded that this screening model can identify women at highest risk of developing cHTN.
Perspective:
Several studies have demonstrated the association between HDP and long-term risk of cHTN. This study aims to refine our understanding of which women are at highest risk by using clinical data and echocardiographic measurements obtained during pregnancy. Interestingly, the predictive model included first trimester blood pressure; however, hypertension that is identified before 20 weeks’ gestation is technically already defined as cHTN (rather than gestational hypertension). Additionally, as one might expect, older maternal age and echocardiographic changes of hypertension were associated with cHTN. This study had a relatively short follow-up period (median 124 days), which also highlights the need for early follow-up and management after pregnancy. Over a longer follow-up period, additional women are likely to develop cHTN and will also benefit from ongoing screening measures and appropriate treatment.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Noninvasive Imaging, Prevention, Vascular Medicine, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Echocardiography/Ultrasound, Hypertension
Keywords: Antihypertensive Agents, Blood Pressure, Body Mass Index, Diagnostic Imaging, Echocardiography, Hypertension, Hypertension, Pregnancy-Induced, Infant, Maternal Age, Peripartum Period, Postpartum Period, Pregnancy, Pregnancy Trimester, First, Primary Prevention, Women
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