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Hypertension during pregnancy increases risk of CVD later

Women who experience hypertension during pregnancy are at increased risk for subsequent cardiovascular disease and hypertension later in life, according to findings published in Paediatric and Perinatal Epidemiology.

“Although different pathologies are believed to cause gestational hypertension and preeclampsia, the magnitude of the association of all [hypertensive disorders in pregnancy] with subsequent CVD remains unclear, as these conditions are often paired with other known CVD risk factors,” Sonia M. Grandi, PhD candidate from the department of epidemiology, biostatistics and occupational health at McGill University in Montreal, and colleagues wrote. “Previous studies examining the association between [hypertensive disorders in pregnancy] and subsequent CVD did not effectively account for subsequent pregnancies and their complications, both of which are potential confounders and intermediates in this association.”

Researchers examined a cohort of 146,748 women with a first pregnancy to determine the link between risk of incident CVD and hypertensive disorders in pregnancy, defined using diagnostic codes, elevated BP readings or new use of an antihypertensive drug between 18 weeks gestation and 6 weeks postpartum.

In total, 997 women were diagnosed with incident CVD and 6,812 were diagnosed with hypertension or received a new antihypertensive medication during follow-up. Women with hypertensive disorders in pregnancy experienced a significantly higher rate of CVD compared to those without (HR = 2.2; 95% CI, 1.7-2.7). The rate of hypertension was five times higher in women with hypertensive disorders in pregnancy than that of women without (HR = 5.6; 95% CI, 5.1-6.3). Subsequent pregnancies did not seem to change these associations. Secondary analysis of time-fixed exposure, defined at first pregnancy, and marginal structural Cox models, used to account for time-varying confounders, demonstrated consistent results for both outcomes.

“Women with a [hypertensive disorder in pregnancy] are at increased risk of developing subsequent CVD,” Grandi and colleagues wrote. “With their higher risk of CVD, women with a history of [hypertensive disorders in pregnancy] may warrant closer long-term follow-up for early management of risk factors for CVD.” – by Savannah Demko

Disclosures: Grandi reports support from a Fonds de recherche du Quebec – Sante Doctoral Award. Please see the full study for a complete list of all other authors’ relevant financial disclosures.