Disclosures: Levine and Chou report no relevant financial information. Please see the study for relevant financial information from all other authors.
A cohort of mostly black women who developed hypertensive disorder in pregnancy were 2.4 times more likely to develop hypertension 10 years later, according to data from a prospective study.
In an analysis of women who participated in an earlier study that recruited women with preeclampsia or gestational hypertension and normotensives, the researchers also found that differences in noninvasive measures of CV risk were primarily due to the diagnosis of hypertension, independent of a history of hypertensive disorder in pregnancy.
“There was an incredibly high prevalence of undiagnosed hypertension where patients would not have known they had chronic hypertension had they not been enrolled in this study,” Lisa D. Levine, MD, MSCE, Michael T. Mennuti, MD, associate professor of reproductive health, division chief of maternal fetal medicine in the department of obstetrics and gynecology, and director of the pregnancy and heart disease program at the Perelman School of Medicine at the University of Pennsylvania, Healio told. “Importantly, patients with a history of preeclampsia or any hypertensive disorder in pregnancy were almost 2.5 times more likely to develop chronic hypertension. The most important point is that it appears that the development of chronic hypertension itself is the determining factor in the development of future heart disease in those patients with a history of hypertensive disorders of pregnancy.
As Healio has already reportedprevious research indicates that hypertension develops faster in women who have experienced hypertensive disorders of pregnancy, up to 10 years earlier, compared to women with normotensive pregnancies.
Assessing hypertension in pregnancy
Lisa D. Levine
In a prospective cross-sectional study, Levine and colleagues analyzed data from 84 patients with and 51 patients without a history of hypertensive disorder of pregnancy randomly selected from a previous study who participated in a follow-up study.
“For the current study, only patients with no history of heart disease, chronic hypertension, or pregestational diabetes at the time of original parental study enrollment (10 years earlier) were included,” they wrote. writes the researchers. “However, patients who developed hypertension, diabetes, or heart disease since the time of their original study enrollment were included, as they were considered outcomes.”
Participants underwent in-person visits with echocardiography, arterial tonometry, and flow-mediated dilation of the brachial artery. The mean initial age was 39 years for women with no history of hypertensive disorder of pregnancy and 36 years for those with a history of hypertension; 85% of the patients were black. Hypertensive disorders of pregnancy were defined as gestational hypertension as well as preeclampsia and superimposed preeclampsia, with or without severe signs.
The findings were published in the Journal of the American College of Cardiology.
The researchers found that patients with a history of hypertensive disorder of pregnancy had a 2.4 times greater risk of new hypertension compared to those without hypertensive disorder of pregnancy (adjusted RR = 2.4; 95% CI , 1.39-4.14) with no difference in measurements of left ventricular structure, overall longitudinal strain, diastolic function, arterial stiffness, or endothelial function.
Regardless of having a history of hypertensive disorder of pregnancy, those who developed hypertension had greater LV remodeling, including greater relative wall thickness, as well as poorer diastolic function, including a ratio e’ and E/A septal and lower lateral. Those who developed hypertension also showed more abnormal longitudinal tension and higher effective arterial elastance compared to patients without hypertension.
“These data underscore the importance of screening patients for the development of hypertension and ensuring that patients and providers are aware of this risk,” Levine told Healio. “Future studies should focus on ways to ensure patients and providers know the overall risk of hypertension after hypertensive disorders of pregnancy, determine best screening practices (how often to screen, screen with AT at home, in the office, etc.) and then assess whether earlier diagnosis, screening and treatment can prevent future cardiovascular disease associated with hypertensive disorders of pregnancy.
“Multi-pronged solutions” needed
In a related editorial, Josephine C. Chou, MD, MS, from the Cardiovascular Medicine Section of Yale University School of Medicine, wrote that black patients are disproportionately affected by hypertensive disorders of pregnancy and their complications; however, it is important to recognize race as a social construct and not as an inherent risk factor for disease.
“There are additional hypertensive disorders of pregnancy heterogeneity in black patients due to differences in socioeconomic indices (employment, income, education, social supports) as well as birth and length of residence at United States,” Chou wrote. “The accumulated stress throughout life due to structural racism, residential segregation and persistent discrimination also negatively affects health and contributes to hypertensive disorders of pregnancy and cardiovascular disease. Thus, addressing the disparate hypertensive disorders of pregnancy and CV outcomes requires multi-pronged solutions that target medical and societal inequalities, in addition to psychological and community factors.
For more information:
Lisa D. Levine, MD, MSCE, can be attached to email@example.com; Twitter: @lisaobdoc.
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