Hypertension during pregnancy linked to long-term cardiovascular risk

Takeaway

• The risk for later cardiovascular diseases, including coronary artery disease, heart failure, aortic stenosis, and mitral regurgitation was higher in women with hypertension during pregnancy.
• History of hypertensive disorders of pregnancy (HDP) was associated with persistently increased arterial stiffness.

Why this matters

• Findings warrant dedicated study in terms of strategy to mitigate long-term cardiovascular risk in women with prior HDP.

Study design

• Study of 220,024 women (aged 40-69 years) who reported ≥1 prior live birth using data from the UK Biobank.
• Incidence of diverse cardiovascular conditions evaluated among parous women with and without prior hypertensive disorders of pregnancy
• Funding: None disclosed.

Key results

• A total of 2808 (1.3%) women had prior HDP.
• After adjustment, prior HDP was associated with higher arterial stiffness index (ASI) by 0.32 m/s (95% CI, 0.13-0.51 m/s; P=.001).
• Women with HDP vs those without HDP had a higher risk for time-to-first incident cardiovascular diagnosis (HR, 1.3; 95% CI, 1.04-1.60; P=.02); age-adjusted disease diagnoses occurred in 7.0 vs 5.3 per 1000 women-years (P=.001).
• Prior HDP was associated with a higher incidence of:
  • coronary artery disease [CAD] (HR, 1.8; 95% CI, 1.3-2.6; P<.001),
  • heart failure (HR, 1.7; 95% CI, 1.04-2.60; P=.03),
  • aortic stenosis (HR, 2.9; 95% CI, 1.5-5.4; P<.001) and
  • mitral regurgitation (HR, 5.0; 95% CI, 1.5-17.1; P=.01).
• Mediation analyses suggested that chronic hypertension accounted for 64% of HDP’s association with CAD (95% CI, 36% to 100%; P<.001) and 49% of HDP’s association with incident heart failure (95% CI, 27% to 100%; P=.02).

Limitations

• Self-reported data.
• Risk of bias.