What question did this study set out to answer?

To determine whether cardiovascular structural and functional phenotypes persist into midlife following a hypertensive pregnancy and evaluate the degree to which they are explained by blood pressure.

April 20, 2020HypertensionOpen Access

Variations in Cardiovascular Structure, Function, and Geometry in Midlife Associated With a History of Hypertensive Pregnancy

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Why the study?

Hypertensive pregnancy increases later maternal cardiovascular risk, but whether pregnancy-associated cardiovascular phenotypes persist into midlife and are explained by blood pressure remained unclear.

Does a history of hypertensive pregnancy alter cardiovascular structure and function in midlife women independent of blood pressure?

Key Points

To determine whether cardiovascular structural and functional phenotypes persist into midlife following a hypertensive pregnancy and evaluate the degree to which they are explained by blood pressure.
Identified 173 women (mean age 42±5 years; 70 normotensive, 103 hypertensive pregnancy) via hospital maternity records 5 to 10 years after pregnancy.
Conducted a single-visit multimodality cardiovascular assessment including cardiac and aortic magnetic resonance imaging, echocardiography, and nailfold capillaroscopy.
Women with a history of hypertensive pregnancy exhibited higher left ventricular mass index (49.9±7.1 vs 46.0±6.5 g/m²; P=0.001), higher ejection fraction (65.6±5.4% vs 63.7±4.3%; P=0.03), lower global longitudinal strain (−18.31±4.46% vs −19.94±3.59%; P=0.02), and increased left atrial volume index (40.4±9.2 vs 37.3±7.3 mL/m²; P=0.03).
Vascular and diastolic parameters were impaired, including reduced E:A ratio (1.34±0.35 vs 1.52±0.45; P=0.003), aortic compliance (0.240±0.053 vs 0.258±0.063; P=0.046), and functional capillary density (105.4±23.0 vs 115.2±20.9 capillaries/mm²; P=0.01).
Differences in functional capillary density (P<0.01), left ventricular mass index (P=0.01), and left atrial volume index (P=0.04) remained statistically significant after adjusting for blood pressure.

Structured PICO

Does a history of hypertensive pregnancy alter cardiovascular structure and function in midlife women independent of blood pressure?

Population

173 women (age 42±5 years) evaluated 5 to 10 years after pregnancy, including 103 with a history of hypertensive pregnancy and 70 with a history of normotensive pregnancy.

Intervention

History of hypertensive pregnancy

Comparator

History of normotensive pregnancy

Outcome

Cardiovascular structure, function, and geometry assessed by multimodality imaging (magnetic resonance imaging of the heart and aorta, echocardiography, and vascular assessment including capillaroscopy)surrogate

A history of hypertensive pregnancy is associated with distinct adverse cardiac structural and microvascular changes in midlife that are independent of current blood pressure.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Should not yet change practice after hypertensive pregnancy; leaves open whether BP-independent remodeling identifies a distinct high-risk phenotype.

Cite This Study

Lamata et al. (2020) studied this question.

synapsesocial.com/papers/6a7f7671fa444d186dca76c5 https://doi.org/10.1161/hypertensionaha.119.14530

Topics

Women and heart disease

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Implication

Should not yet change practice after hypertensive pregnancy; leaves open whether BP-independent remodeling identifies a distinct high-risk phenotype.

Variations in Cardiovascular Structure, Function, and Geometry in Midlife Associated With a History of Hypertensive Pregnancy

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Variations in Cardiovascular Structure, Function, and Geometry in Midlife Associated With a History of Hypertensive Pregnancy

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider