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High BP during pregnancy increased long-term CVD risk
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High BP during pregnancy can the raise risk for heart and kidney disease and diabetes later in life, according to recent study results published in Circulation.
Researchers looked at less serious forms of high BP that are more common in pregnant women. The study followed 10,314 Finnish women who had babies in 1966 for 40 years to calculate the risk for heart or kidney disease or diabetes in later life among women with high BP during pregnancy.
Researchers found gestational hypertension was associated with increased risk for ischemic heart disease (HR=1.44; 95% CI, 1.24-1.68), MI (HR=1.75; 95% CI, 1.4-2.19), MI death (HR=3.0; 95% CI, 1.98-4.55), HF (HR=1.78; 95% CI, 1.43-2.21), ischemic stroke (HR=1.59; 95% CI, 1.24-2.04), kidney disease (HR=1.91; 95% CI, 1.18-3.09) and diabetes (HR=1.52; 95% CI, 1.21-1.89). They also noted an association between isolated diastolic hypertension and increased risk for ischemic heart disease (HR=1.42; 95% CI, 1.05-1.5). However, isolated systolic hypertension was associated with an increased risk for MI death (HR=2.15; 95% CI, 1.35-3.41), HF (HR=1.43; 95% CI, 1.13-1.82) and diabetes (HR=1.42; 95% CI, 1.13-1.78).
Women who had high BP during pregnancy had 14% to more than 100% higher risk for CVD later in life compared with those who had normal BP, the researchers said.
“According to our findings, women who have had high BP during pregnancy or who are diagnosed with high BP in pregnancy for the first time might benefit from comprehensive heart disease risk factor checks by their physicians, to decrease their long-term risk of heart disease,” study researcher Tuija Männistö, MD, PhD, a postdoctoral fellow at the NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development in Rockville, Md., said in a press release.
Researchers found new-onset isolated elevation in systolic or diastolic BP during pregnancy in about 17% of all women. About 30% of them had a CV event before their late 60s and 3% died of MIs, according to the study results.
Primary and cardiac care for women should include an assessment of any history of elevated BP during pregnancy, and additional monitoring and CV risk factor evaluation may be warranted in women with such history to prevent poor outcomes later in life, they said.
Disclosure: The researchers report to relevant financial disclosures.
Perspective
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Roxana Mehran, MD
This well-conducted study provides enhanced data on the relationship of pregnancy-related complications and subsequent risk for heart-related problems. The results of the study were not surprising. However, to date, there has never been a definitive study to say that follow-up on women who have pregnancy-related complications, such as diabetes and pre-eclampsia, merits important value.
The evidence certainly becomes stronger that we should be screening women earlier and considering pregnancy-related complications as a serious matter for the future of their heart health. This study underlines that.
The data also bring to light a study we conducted through the Women in Innovations Initiative as part of the Society for Cardiovascular Angiography & Interventions. This was a 3,000-patient study surveying women who were being seen in ob-gyn offices. This study uncovered a high prevalence of CV risk in the women screened as well as an important interaction of pregnancy related complications with these risk factors. We found that 87% of these women had at least one risk factor for CVD; many had pregnancy-related complications. When you have hypertension or diabetes during pregnancy it may have important late implications with increasing the risk for CVD late post pregnancy. This concept is understudied. Once these women have their babies, the diabetes and the hypertension dissipates. The woman is happy with her baby and she forgets about her risks.
Hopefully, this study will remind us that if a woman had hypertension during pregnancy she should be followed carefully to be sure that she remain at goal for all CV risks. That's not currently being done. This research also underlines the importance of CVD risk in the female patient population that was previously completely overlooked. In order for us to make an impact on improving mortality and CV mortality in women, we have to be thinking about these risk factors, educating women, and getting their attention in that teachable moment during pregnancy rather than waiting until it's developed because then it could be too late.
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