BACKGROUND AND PURPOSE:

• Hypertensive disorders of pregnancy (HDP) are known to be associated with an increased risk of cardiovascular disease (CVD) 20 to 30 years after the hypertensive event
• CVD risk in the first decade after the event has been less studied
• Levine et al. (Journal of the American College of Cardiology, 2022) sought to evaluate CV risk factors and subclinical CVD within the first 10 years following the HDP event

METHODS:

• Prospective cohort study
• Participants
  • HDP (physician confirmed)
  • History of pregnancy but no HDP
• Exposures
  • History of HDP ≥10 years earlier
• Study design
  • In-person visits with echocardiography, arterial tonometry, and flow-mediated dilation of the brachial artery
• Primary outcomes
  • Risk for CVD at 10 years post HDP
  • Noninvasive measures of cardiac and vascular structure and function

RESULTS:

• History of HDP: 84 participants | No history: 51 participants
  • Self-identified as Black: 85%
• Patients with a history of HDP had a 2.4-fold increased risk of new hypertension compared with those without HDP
  • History of HDP: 56.0%
  • No history: 23.5%
  • Adjusted relative risk 2.4 (95% CI, 1.39 to 4.14)
• There were no differences in
  • Measures of left ventricular structure
  • Global longitudinal strain
  • Diastolic function
  • Arterial stiffness
  • Endothelial function
• Compared to participants without hypertension, participants who developed hypertension, regardless of HDP history, had
  • Greater left ventricular remodeling including greater relative wall thickness
  • Worse diastolic function
  • More abnormal longitudinal strain
  • Higher effective arterial elastance

CONCLUSION:

• Patients with a history of hypertensive disorders of pregnancy had a 2.4-fold higher risk of hypertension 10 years after the HDP event
• Differences in noninvasive measures of CVD risk were primarily driven by the diagnosis of hypertension
• The authors state

Differences in noninvasive measures of CV risk were driven mostly by the hypertension diagnosis, regardless of HDP history, suggesting that the known long-term risk of CVD after HDP may primarily be a consequence of hypertension development

Learn More – Primary Sources:

Prospective Evaluation of Cardiovascular Risk 10 Years After a Hypertensive Disorder of Pregnancy

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