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Grand Rounds

Hypertensive Disorders of Pregnancy: Is There an Increased Cardiovascular Risk in the First 10 Years After Delivery?

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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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Related ObG Topics:

Does Hypertension in Pregnancy Predict Hypertension Later in Life?
Does Postpartum BP Self-Management Reduce Long-Term Adverse Events in Women with Hypertensive Disorders of Pregnancy
Does Preterm Birth Increase Risk of Subsequent CVD in Mothers?

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