Women developing high BP during pregnancy at higher risk of CVD later: JACC

USA: Women who experience preeclampsia -- pregnancy complication characterized by high blood pressure -- in at least one pregnancy are at a higher risk of cardiovascular disease (CVD) than women without such history, finds a recent study. This increased risk persists at least into their 60s.

According to the study, published in the Journal of the American College of Cardiology, hypertensive disorders of pregnancy are associated with accelerated cardiovascular ageing and more diverse cardiovascular conditions than previously appreciated.

Previous research has shown the presence of sex-specific risk factors for CVD among women. But there were significant gaps in the understanding of those risks, and one gap is whether the elevated risk persists long-term after a hypertensive pregnancy, or whether other women 'catch up' as cardiovascular risk increases with age in the population overall. Michael C. Honigberg, of Massachusetts General Hospital's (MGH) Cardiology Division, and colleagues examine the long-term incidence of diverse cardiovascular conditions among middle-aged women with and without prior hypertensive disorder of pregnancy (HDP).

The study included 220,024 women, from the observational UK Biobank age 40 to 69 years (mean age 57.4 ± 7.8 years) who reported ≥1 live birth; of which 2,808 (1.3%) had prior HDP. Noninvasive arterial stiffness measurement was performed in a subset of women. The women were followed for a median 7 years (interquartile range: 6.3 to 7.7 years).

Key findings of the study include:

• Women with HDP had elevated arterial stiffness indexes and a greater prevalence of chronic hypertension compared with women without HDP.


• Overall, 7.0 versus 5.3 age-adjusted incident cardiovascular conditions occurred per 1,000 women-years for women with versus without prior HDP, respectively.


• An analysis of time-to-first incident cardiovascular diagnosis, prior HDP was associated with a hazard ratio (HR) of 1.3.


• HDP was associated with a greater incidence of CAD (HR: 1.8), heart failure (HR: 1.7), aortic stenosis (HR: 2.9), and mitral regurgitation (HR: 5.0).


• In causal mediation analyses, chronic hypertension explained 64% of HDP’s association with CAD and 49% of HDP’s association with heart failure.

"We're still figuring out how to predict and prevent hypertensive disorders in pregnancy," said Honigberg. "But what we can do is look ahead and try to mitigate the risk of these women developing cardiovascular disease later in life." That includes common-sense heart-healthy modifications such as exercising, eating healthy, not smoking and controlling weight. Some may additionally benefit from preventive medications.

"You'd be shocked at how few physicians who aren't obstetrician/gynaecologists -- including cardiologists -- ask their female patients if they've had a hypertensive disorder of pregnancy," Honigberg said. "This research really underscores the importance of clinicians asking about this history and of women sharing it."

"Hypertensive disorders of pregnancy are associated with accelerated cardiovascular aging and more diverse cardiovascular conditions than previously appreciated, including valvular heart disease. Cardiovascular risk after HDP is largely but incompletely mediated by the development of chronic hypertension," wrote the authors.

More Information: "Long-Term Cardiovascular Risk in Women With Hypertension During Pregnancy" published in the Journal of the American College of Cardiology.

DOI: https://doi.org/10.1016/j.jacc.2019.09.052

Journal Information: Journal of the American College of Cardiology.