A new study suggests that women with hypertensive pregnancy disorders should have regular cardiovascular exams even if they don’t show symptoms of cardiovascular disease.
Analysis of data from 132 women suggests that women with a history of hypertensive pregnancy disorder exhibited notable differences in left ventricular structure and function a decade after pregnancy.
“Hypertension is a silent killer,” senior investigator Malamo Countouris, MD, clinical instructor in cardiology at the Pitt Medical Department and co-director of the postpartum hypertension clinic at UPMC Magee-Womens Hospital, said in a statement. “None of the women in our study had clinical symptoms of heart disease – they are young and likely to feel fine and healthy and may not see a doctor regularly – but it’s important to get them screened for high blood pressure early.”
A team from the University of Pittsburgh, led by Countouris, tried to study the long-term effects of hypertensive pregnancy disorders on remodeling of the heart. To that end, the researchers designed their study as an analysis of data from women identified in the University of Pittsburgh’s Magee Obstetric Maternal and Infant database. From the database, the investigators obtained information on the medical history of women with pregnancies between 2008 and 2009. These women were then asked to participate in an additional one; Visit between 2017-2019, where transthoracic echocardiograms and assessments of height, weight and blood pressure were performed according to standardized methods.
In total, the investigators identified 132 women for inclusion in their study. Of these, 102 had normotensive pregnancies and 30 had hypertensive pregnancies, including 21 with preeclampsia and 9 with gestational hypertension. The total cohort was 10 ± 1 years away from delivery and had a mean age of 39 ± 6 years. Of the women with pre-eclampsia, 6 had severe pre-eclampsia and 7 had premature delivery.
According to the analysis, those with hypertensive pregnancy disorders during their index pregnancy 8-10 years after delivery were more likely to have current hypertension than their counterparts without hypertensive pregnancy disorders, as measured by blood pressure or use of antihypertensive drugs (63.3%) vs 25.5% ; P <0.0001). In addition, women with hypertensive pregnancy disorders were more likely to have diabetes (20.7% versus 7.0%; P = 0.03), higher systolic blood pressure (125 ± 12 mmHg versus 114 ± 13 mmHg; P <0.0001), and one higher diastolic blood pressure (82 ± 10 mmHg versus 74 ± 9 mmHg; P <0.0001), and there appeared to be a trend towards a higher proportion of maternal placental vascular perfusion lesions (MVM) (63.3% versus 45.1%) ; P = 0.08)).
Adjusted for race, age, MVM lesions, BMI, current hypertension, and HbA1c, women with a history of hypertensive pregnancy disorders had greater interventricular septal thickness and relative wall thickness than women with normotensive pregnancies. Further analyzes showed that both a history of hypertensive pregnancy disorders and current hypertension showed greater proportions of left ventricular remodeling compared to all other groups. In addition, the researchers found that these patients also had a lower mitral inflow I / O ratio and an annular e ‘.
“Identifying women at high risk can provide a window of opportunity for targeted interventions to prevent heart disease,” Countouris said. “Suggesting simple lifestyle or diet changes, including regular exercise and better management of other cardiovascular risk factors, can prevent adverse changes in the heart and lower the risk of heart disease later in life.”
This study, “Association of Hypertensive Pregnancy Disorders with Left Ventricular Remodeling Later in Life,” was published in the Journal of the American College of Cardiology.
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