HT, stroke risk up after hypertension during pregnancy

Women who had hypertension during pregnancy are at increased risk for hypertension and stroke after 40 years of age, based on follow-up data from more than 4,000 women.

The findings suggest that clinicians should ask patients about a history of hypertension in pregnancy and recognize the increased risk of hypertension and stroke in women with such a history according to the department of nephrology and hypertension at the Mayo Clinic in Rochester, Minn.

More doctors are recognizing an association between hypertension in pregnancy and cardiovascular disease (CVD) later in life. The current findings support previous research, but earlier studies have been small and registry based, with limited follow-up, as said at the annual congress of the international Society for the Study of Hypertension in Pregnancy.

In this study, a review of data from 4,782 women who participated in the Family Blood Pressure Program, a large, multicenter genetic study of high blood pressure and related conditions was made. Their goal was to assess the role of hypertension in pregnancy as a risk factor for stroke and coronary heart disease later in life.

The women were divided into three categories, those with no history of pregnancy lasting more than 6 months, those with no history of hypertension in pregnancy and those with a history of hypertension in at least one pregnancy. The investigators also asked the women about other risk factors, including a family history of hypertension and a history of smoking.

The investigators tracked hypertension and related conditions after the women reached 40 years of age. Overall, the women with a history of hypertension in pregnancy had a significant increased risk for hypertension, coronary heart disease (CHD) and stroke, compared with the women who were not hypertensive in pregnancy.

After controlling for cardiovascular factors including race, family history of CVD, diabetes, dyslipidemia, and smoking, only the risk for hypertension later in life was significantly higher. After controlling for risk factors for stroke, including subsequent hypertension, the risk for stroke was significantly increased but the risk for CHD was not.

In addition, the women with a history of hypertension in pregnancy developed hypertension at a younger age than did the women who were not hypertensive in pregnancy.

Of the 643 women who had a history of hypertension in at least one pregnancy, 50 percent were hypertensive by age 53 years.

You can postulate that these women have some underlying increased risk. On the other hand, hypertension in pregnancy may cause changes that contribute to an increased risk of future cardiovascular disease.

The mechanism of action that connects hypertension in pregnancy to subsequent disease risk remains unknown.–Charles C. Chante, MD (The Philippine Star)