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Women with early-onset preeclampsia may have more pronounced LV remodeling after delivery
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Women with early-onset preeclampsia had more pronounced left ventricular concentric remodeling at 1 month after delivery compared with women who had late-onset preeclampsia, according to data presented at the American Heart Association Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, American Society of Hypertension Joint Scientific Sessions.
“These women should be screened for major cardiovascular risk factors and prevention strategies should be implemented as soon as possible,” GianLuca Colussi, MD, assistant professor of medicine at the University of Udine in Italy, said in a press release. “We’ve shown that women with early-onset preeclampsia might be at even greater risk, suggesting preventive interventions such as using medications that act on left ventricular remodeling.”
Postpartum analysis
Colussi and colleagues analyzed data from 65 women (mean age, 36 years) developed preeclampsia during pregnancy. Of those, 37% had early-onset preeclampsia. All women had no history of high BP before pregnancy.
The researchers compared data from the women with preeclampsia at 1 month after delivery with data from 16 women who were hypertensive and not pregnant (mean age, 40 years), 30 women who were normotensive (mean age, 37 years) and six women with normal pregnancies (mean age, 36 years).
One month after delivery, those women with early-onset preeclampsia had lower 24-hour systolic and diastolic BP compared with women with late-onset preeclampsia: 125 mm Hg vs. 136 mm Hg.
Further, the researchers reported significantly greater LV relative wall thickness among women with early-onset preeclampsia compared with those with late-onset preeclampsia (0.36 vs. 0.31; P < .05) and those who were normotensive (0.36 vs. 0.3; P < .05); the difference in LV relative wall thickness was not observed in the group of hypertensive women. Compared with normotensive women, those with early- and late-onset preeclampsia also had greater LV mass and worse diastolic function and isovolumic relaxation time.
The findings in this study “could account for the greater cardiovascular risk of these patients and might prompt the use of antihypertensive drugs specifically acting on LV remodeling,” Colussi and colleagues wrote in the abstract.
Telehealth monitoring, treatment
Another abstract presented at the meeting focused on women with postpartum hypertension disorders who were successfully monitored and treated via telehealth.
“Postpartum hypertension is a leading indication for hospital readmission and maternal mortality,” Kara K. Hoppe, DO, assistant professor of maternal-fetal medicine at the department of obstetrics and gynecology at the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues wrote in the abstract.
The study focused on 32 women with a hypertension-related diagnosis during pregnancy or after delivery. Women were given a tablet computer and Bluetooth-capable equipment such as a heart rate and BP monitor before discharge. A nurse telehealth visit was scheduled 48 hours and 7 days after discharge. Initiation and/or cessation of antihypertensive medications were controlled by a nurse-driven outpatient treatment algorithm. Patients were followed up for 6 weeks postpartum, followed by routine clinical care.
At discharge, 19% of women were given antihypertensive medication, 67% of whom required increased doses. After discharge, antihypertensive medication was initiated in 31% of women to treat severe hypertension.
The most severe postpartum BP (mean, 158/96 mm Hg) was measured 5 days after discharge.
No hospital readmissions and two ED visits occurred during follow-up.
“The preliminary results of our pilot intervention demonstrate feasibility and patient acceptability with telehealth monitoring for postpartum hypertension-related disorders. … Telehealth monitoring is a promising outpatient treatment strategy for postpartum hypertension to reduce readmissions and decrease maternal morbidity,” Hoppe and colleagues wrote. – by Darlene Dobkowski
References:
Colussi G, et al. Presentation #26.
Hoppe KK, et al. Presentation #34. Both presented at: AHA Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, American Society of Hypertension Joint Scientific Sessions; Sept. 14-17, 2017; San Francisco.
Disclosures: The authors report no relevant financial disclosures.