Hypertensive Disorders of Pregnancy: Is There an Increased Cardiovascular Risk in the First 10 Years After Delivery?
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
Prospective cohort study
HDP (physician confirmed)
History of pregnancy but no HDP
History of HDP ≥10 years earlier
In-person visits with echocardiography, arterial tonometry, and flow-mediated dilation of the brachial artery
Risk for CVD at 10 years post HDP
Noninvasive measures of cardiac and vascular structure and function
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
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
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
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