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| 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.
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
ReplyDeleteThanks, 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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