SAN FRANCISCO — Hypertensive disorders in pregnancy may signal future arrhythmia and heart failure risk in middle age, a population-based study affirmed.
Heart failure risk was 88% higher among women with a history of hypertensive pregnancy than the rate among women with a normotensive pregnancy (P=0.013), Dawn C. Scantlebury, MD, of the Mayo Clinic in Rochester, Minn., and colleagues found.
Similarly, arrhythmia risk was 27% higher with hypertension in pregnancy (P=0.035), the group reported here at the American Society of Hypertension meeting.
The findings couldn’t determine causality, which would require an entirely different study design, cautioned Marshall Lindheimer, MD, of the University of Chicago Medical Center, who served as a judge at the young-investigator abstract competition session.
A recent population-based study from Finland that was able to separate out the various categories of hypertension in pregnancy showed substantial elevations in problems ranging from fatal heart attack to kidney disease, stroke, heart failure, and diabetes over almost 40 years of follow-up after even gestational hypertension without proteinuria.
Associations persisted among nonsmokers younger than 35 with normal weight and no gestational diabetes, supporting an independent impact of blood pressure.
Yet from the clinical perspective, “whether it’s an independent effect or a non-independent effect doesn’t matter,” Scantlebury told MedPage Today in an interview.
“We’ve identified a group of women who have shown a signal they will have some kind of bad coronary outcome, so these women should be watched. These should be women who see their physician every year instead of having their babies and then 10, 15, 20 years later go back to their physician because they have a cold or something.”
These women usually do drop under the radar after pregnancy, commented session moderator Raymond R. Townsend, MD, of the University of Pennsylvania in Philadelphia.
“The follow-up is what’s the key issue here,” he agreed in an interview. “These are people we might be able to use the recent issues with high blood pressure in pregnancy as a sort of incentive to be more on board with lifestyle and other changes.”
Primary care or pediatrics visits might be good opportunities, he suggested. “If you wait for ob/gyn to do this, they’re probably going to lose 10 to 15 years of potential intervention time.”
The study included all 7,819 women who had a pregnancy delivered in Olmsted County from 1976 through 1982 with follow up in the Rochester Epidemiology Project, which includes near complete medical records for residents in the country.
Among them, 617 had some form of hypertension at the time of pregnancy (average age 26), whether preexisting or gestational.
Women were followed until the outcome of interest, the last medical visit, or death, which occurred in the range of 41 to 61 years of age.
No significant association was seen with conduction disorders between those with hypertension in pregnancy and those without it (P=0.43).
The study spread a broad net for diagnostic codes even including symptoms suggestive of hypertensive disorders, such as edema or seizure, and pregnancy outcomes associated with them, like placental abruption and intrauterine growth restriction, along with the clearer preeclampsia or eclampsia diagnoses.
Myron Weinberger, MD, of Indiana University in Indianapolis, another judge at the session, cautioned that it might not be appropriate to lump all these various codes together into one entity.
Separating the different forms of hypertension in pregnancy will be the next phase of the study, Scantlebury noted.
The medical records have to be abstracted for the relevant data because of missed diagnoses and changes in definitions across the study period and also in order to do multivariate adjustment for confounding, she explained.
Source: MedPage Today.
