Hypertension in Pregnancy and Future Cardiovascular Disease

Hypertension in Pregnancy and Future Cardiovascular Disease

Stacey Ann Dixon Grandison, Vesna D Garovic


| More
dots

Gender-specific factors that may influence the onset of cardiovascular disease (CVD), its clinical course, the efficacy of therapy, and prognosis have long been ignored. Renewed interest in female-specific conditions occurred as a result of the CVD pandemic in women, when it became apparent that the decline in cardiovascular mortality in men was not associated with a similar rate of decline in women.1 Clinical studies exploring gender-based disparities have indicated that women have been both underevaluated for CVD and undertreated for modifiable CVD risk factors.2,3

On the research side, it has become apparent that the relative significance of known CVD risk

Hypertension in pregnancy includes a spectrum of conditions, including pre-eclampsia–eclampsia, pre-eclampsia superimposed on chronic hypertension, chronic hypertension, and gestational hypertension. factors may be gender-specific.4 In addition, research efforts have focused on conditions unique to women, such as contraception, menopause and hormone-replacement therapy, and hypertension in pregnancy.

It is estimated that about 10% of pregnancies are affected by hypertension worldwide. Hypertension in pregnancy includes a spectrum of conditions,5including pre-eclampsia–eclampsia, pre-eclampsia superimposed on chronic hypertension, chronic hypertension, and gestational hypertension (see Table 1). Approximately half of all hypertensive pregnancy disorders are due to preeclampsia, a pregnancy-specific multisystem disorder that is clinically characterized by hypertension and proteinuria that occurs after 20 weeks of gestation. The purpose of this article is to present the evidence-based data that support the associations between hypertension in pregnancy on the one hand and future hypertension, coronary heart disease (CHD), and stroke on the other. In addition, the possible mechanisms that may underlie these associations will be discussed, along with the guidelines for long-term follow-up and management of these patients.

Hypertension in Pregnancy and Risk for Hypertension
Later in LifeWhile an association between pre-eclampsia and the future development of hypertension and renal disease was first recognized in the 19th century, this association was challenged by Chesley and colleagues in the early 1970s.6,7 In their frequently cited study, they reported that primiparous pre-eclamptic women were not different from controls in terms of the development of hypertension, mortality secondary to CVD, or overall mortality. This study had several serious limitations, most notably small sample sizes and a suboptimal control group, which consisted of women from previously published epidemiological studies, conceivably including some women with hypertensive pregnancy disorders in addition to those with normotensive pregnancies. Despite these limitations, the results of this study served as a basis for the widely accepted view that hypertensive diseases of pregnancy are limited to the affected pregnancy and have few, if any, long-term maternal effects.

1234next ›last »
References:
  1. Mosca L, Manson JE, Sutherland SE, et al., Cardiovascular Disease in Women: A Statement for Healthcare Professionals From the American Heart Association, Circulation, 1997;96 (7):2468–82.
  2. Mosca L, Linfante AH, Benjamin EJ, et al., National study of physician awareness and adherence to cardiovascular disease prevention guidelines, Circulation, 2005;111(4):499–510.
  3. Abuful A, Gidron Y, Henkin Y, Physicians’ attitudes toward preventive therapy for coronary artery disease: is there a gender bias?, Clin Cardiol, 2005;28(8):389–93.
  4. Stangl V, Baumann G, Stangl K, Coronary atherogenic risk factors in women, Eur Heart J, 2002;23(22):1738–52.
  5. Anonymous, Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy, Am J Obstet Gynecol, 2000;183(1):S1–S22.
  6. Chesley SC, Annitto JE, Cosgrove RA, The remote prognosis of eclamptic women. Sixth periodic report, Am J Obstet Gynecol, 1976;124(5):446–59.
  7. Chesley LC, Recognition of the long-term sequelae of eclampsia, Am J Obstet Gynecol, 2000;182(1 Pt. 1):249–50.
  8. Sibai BM, el-Nazer A, Gonzalez-Ruiz A, Severe preeclampsia-eclampsia in young primigravid women: subsequent pregnancy outcome and remote prognosis, Am J Obstet Gynecol, 1986; 155(5):1011–16.
  9. Lindeberg S, Axelsson O, Jorner U, et al., A prospective controlled five-year follow-up study of primiparas with gestational hypertension, Acta Obstet Gynecol Scand, 1988;67(7):605–9.
  10. Selvaggi L, Loverro G, Schena FP, et al., Long term follow-up of women with hypertension in pregnancy, Int J Gynaecol Obstet, 1988;27(1):45–9.
  11. Carleton H, Forsythe A, Flores R, Remote prognosis of preeclampsia in women 25 years old and younger, Am J Obstet Gynecol, 1988;159(1):156–60.
  12. Marin R, Gorostidi M, Portal CG, et al., Long-term prognosis of hypertension in pregnancy, Hypertens Pregnancy, 2000;19(2): 199–209.
  13. Diehl CL, Brost BC, Hogan MC, et al., Preeclampsia as a risk factor for cardiovascular disease later in life: validation of a preeclampsia questionnaire, Am J Obstet Gynecol, 2008;198(5):e11–13.
  14. Bellamy L, Casas JP, Hingorani AD, Williams DJ, Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis, BMJ, 2007;335(7627):974.
  15. Jonsdottir LS, Arngrimsson R, Geirsson RT, et al., Death rates from ischemic heart disease in women with a history of hypertension in pregnancy, Acta Obstet Gynecol Scand, 1995;74(10):772–6.
  16. Smith GC, Pell JP, Walsh D, Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129,290 births, Lancet, 2001;357(9273):2002–6.
  17. Hannaford P, Ferry S, Hirsch S, Cardiovascular sequelae of toxaemia of pregnancy, Heart, 1997;77(2):154–8.
  18. Irgens HU, Reisaeter L, Irgens LM, Lie RT, Long term mortality of mothers and fathers after pre-eclampsia: population based cohort study, BMJ, 2001;323(7323):1213–17.
  19. Ray JG, Vermeulen MJ, Schull MJ, Redelmeier DA, Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study, Lancet, 2005;366(9499): 1797–1803.
  20. Croft P, Hannaford PC, Risk factors for acute myocardial infarction in women: evidence from the Royal College of General Practitioners’ oral contraception study, BMJ, 1989;298(6667): 165–8.
  21. Arnadottir GA, Geirsson RT, Arngrimsson R, et al., Cardiovascular death in women who had hypertension in pregnancy: a case-control study, BJOG, 2005;112(3):286–92.
  22. Kestenbaum B, Seliger SL, Easterling TR, et al., Cardiovascular and thromboembolic events following hypertensive pregnancy, Am J Kidney Dis, 2003;42(5):982–9.
  23. Wikstrom A-K, Haglund B, Olovsson M, Lindeberg SN, The risk of maternal ischaemic heart disease after gestational hypertensive disease, BJOG, 2005;112(11):1486–91.
  24. Anonymous, Venous thromboembolic disease and combined oral contraceptives: results of international multicentre case-control study. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception, Lancet, 1995;346(8990):1575–82.
  25. Anonymous, Haemorrhagic stroke, overall stroke risk, and combined oral contraceptives: results of an international, multicentre, case-control study. WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception, Lancet, 1996;348(9026):505–10.
  26. Brown DW, Dueker N, Jamieson DJ, et al., Preeclampsia and the Risk of Ischemic Stroke Among Young Women: Results From the Stroke Prevention in Young Women Study, Stroke, 2006;37(4): 1055–9.
  27. Wilson BJ, Watson MS, Prescott GJ, et al., Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study, BMJ, 2003;326(7394):845.
  28. Garovic VD, Hayman SR, Hypertension in pregnancy: an emerging risk factor for cardiovascular disease, Nat Clin Pract Nephrol, 2007; 3(11):613–22.
  29. Laivuori H, Tikkanen MJ, Ylikorkala O, Hyperinsulinemia 17 years after preeclamptic first pregnancy, J Clin Endocrinol Metab, 1996; 81(8):2908–11.
  30. Chambers JC, Fusi L, Malik IS, et al., Association of maternal endothelial dysfunction with preeclampsia, JAMA, 2001;285(12): 1607–12.
  31. Agatisa PK, Ness RB, Roberts JM, et al., Impairment of endothelial function in women with a history of preeclampsia: an indicator of cardiovascular risk, Am J Physiol Heart Circ Physiol, 2004;286(4): H1389–93.
  32. Zeeman GG, Fleckenstein JL, Twickler DM, Cunningham FG, Cerebral infarction in eclampsia, Am J Obstet Gynecol, 2004; 190(3):714–20.
  33. Aukes AM, Wessel I, Dubois AM, et al., Self-reported cognitive functioning in formerly eclamptic women, Am J Obstet Gynecol, 2007;197(4):365. US

Copyright® 2004 - 2010 Business Briefings, Ltd. All rights reserved.
Touch Endocrinology is for informational purposes and should not be considered medical advice, diagnosis or treatement recommendations.