Saturday, September 16, 2017

Any type of hypertension in pregnancy incurs high future risk of cardiovascular disease

courtesy: indiatimes.com
Women presenting with any subtype of hypertensive disorders of pregnancy (HDP) are at increased risk of developing future hypertension, Ischemic Heart Disease (IHD), stroke and renal disease reports the results of a large retrospective cohort study epub ahead of print in journal Hypertension.

The results demonstrate that women with any type of hypertension during pregnancy are 2.78 times the risk of future hypertension, nearly twice the risk of IHD and stroke and 2.76 times the risk of renal disease as compared to women who were normotensive during pregnancy.

Contrary to popular belief, the highest risk is faced by women with gestational hypertension (OR, 4.08; CI,3.23–5.10) and not by women with preeclampsia during pregnancy (OR,3.06; CI,2.18–4.29).

Women with preeclampsia in pregnancy are nearly 5 times at risk of developing renal disease as compared to their normotensive counterparts during pregnancy (OR, 4.74; CI, 2.19 –10.20).

This retrospective study was conducted at a metropolitan tertiary hospital in Sydney, Australia, across a period of nine years. Data was extracted from medical records. A total of 31 656 deliveries took place during the study period out of which HDP was diagnosed in 4387 (13.8%) women, whereas 27262 (86.2%) of the women remained normotensive in their pregnancy.

The time to develop CVD from index pregnancy varied between 3 to 29 years, the median being 20 years. Future risk of developing CVD also increased proportionately as the severity of HDP increases. Women with preeclampsia also had more severe hypertension as compared to women with gestational hypertension. Women with severe HDP were older, deliver early in pregnancy and have babies that are small for gestational age.

Women who delivered ≤34 weeks gestation also are at increased and early risk of future CVD and as compared to women who delivered >34 weeks gestation. Receiving anti-hypertensive medication during pregnancy did not alter the future risk of developing CVD, although it benefited maternal and fetal outcome.

Under-reporting of chronic hypertension in young women might have limited some aspects of data analysis.

Hence, these women who have history of HDP should be explained in detail about their future risk of CVD and renal diseases. They should be advised a lifelong close monitoring for B.P and other modifiable risk factors for the development of CVD.

Cardiovascular risk assessment should also include obstetric history of women.

Further research is warranted to look into prevention of CVD after the risk is identified early in disease course.




3 comments:

  1. What is the exact mechanism by which hypertension occurs in later life say in mid thirties or decades of fifties in women who had had PIH in preg period? Any measures that may be adopted in pregnancy period or subsequent to childbirth which will reduce the prevalence of such enhanced rate of hypertension in later life in these subset of women ?drsrimantapal@gmail.com

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  2. Thanks, Dr Pal. Multiple studies have indicated that accelerated atherosclerosis underlies this increased CVD risk. Furthermore, it has been suggested that endothelial dysfunction and inflammation play an important role in the increased CVD risk of women with preecclampsia. Close postnatal follow up and identifying these high risk women (because of history of preecclampsia) early in disease is the first step in modifying future risk of CVD.

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