Hypertensive Disorders of Pregnancy Associated with Heart Disease Risk a Decade Later

Malamo Countouris, MD

A new study suggests women with hypertensive disorders of pregnancy should undergo regular cardiovascular screenings, even if they are not showing symptoms of cardiovascular disease.

An analysis of data from 132 women suggests women with a history of hypertensive disorders of pregnancy had notable differences in left ventricular structure and function a decade after pregnancy.

"Hypertension is a silent killer," said lead investigator Malamo Countouris, MD, a clinical instructor in cardiology at Pitt's Department of Medicine and a co-director of the UPMC Magee-Womens Hospital Postpartum Hypertension Clinic, in a statement. "None of the women in our study had clinical symptoms of heart disease—they are young and probably feel well and healthy, and may not be seeing a health care provider regularly—but it's important to start screening them for high blood pressure early."

Led by Countouris, a team from the University of Pittsburgh sought to examine the long-term effects of hypertensive disorders of pregnancy on cardiac remodeling. To do so, investigators designed their study as an analysis of data from women identified within the Magee Obstetric Maternal and Infant database from the University of Pittsburgh. From the database, investigators obtained information related to medical history of women with pregnancies delivered from 2008-2009. These women were then asked to take part in an additional; visit between 2017-2019 where they underwent transthoracic echocardiograms and assessments ofheight, weight, and blood pressure by standardized methods.

In total, investigators identified 132 women for inclusion in their study. Of these, 102 had normotensive pregnancies and 30 had hypertensive digs-orders of pregnancy, including 21 with pre-eclampsia and 9 with gestational hypertension. The overall cohort was 10±1 years removed from delivery and had a mean age of 39±6 years. Of the women with pre-eclampisa, 6 had severe pre-eclampsia and 7 experienced a pre-term delivery.

Upon analysis, those with hypertensive disorders of pregnancy during their index pregnancy were more likely to have current hypertension at 8-10 years after delivery compared to their counterparts without hypertensive disorders of pregnancy when measured according to visit blood pressure or antihypertensive medication use (63.3% vs 25.5%; P <.0001). Additionally, women with hypertensive disorders of pregnancy were more likely to have diabetes (20.7% vs 7.0%; P=.03), higher systolic blood pressure (125±12 mmHg vs 114±13 mmHg; P <.0001), higher diastolic blood pressure (82 ±10 mmHg vs 74±9 mmHg; P <.0001), and there appeared to be a trend toward a higher proportion of placental maternal vascular malperfusion (MVM) lesions (63.3% vs 45.1%; P=.08).

After adjustment for race, age, MVM lesions, BMI, current hypertension, and HbA1c, women with a history of hypertensive disorders of pregnancy had greater inter ventricular septal thickness and relative wall thickness then those with normotensive pregnancies. Further analysis indicated both a history of hypertensive disorders of pregnancy and current hypertension had greater portions of left ventricular remodeling compared to all other groups. Additionally, investigators noted these patients also had lower mitral inflow E/A ratio and annular e’.

"Identifying women at high risk can provide a window of opportunity for targeted interventions to prevent heart disease," said Countouris. "Suggesting simple changes in lifestyle or diet, including regular exercise and better management of other cardiovascular risk factors, can prevent adverse changes in the heart and lower the risk of heart disease later in life."

This study, “Association of Hypertensive Disorders of Pregnancy With Left Ventricular Remodeling Later in Life,” was published in the Journal of the American College of Cardiology.