P reeclampsia (PE), a serious hypertensive pregnancy disorder complicating 2% to 5% of all pregnancies, is characterized by new-onset hypertension along with de novo proteinuria after 20 weeks of gestation 1 or new-onset proteinuria that develops after 20 weeks in women with preexisting hypertension. Women with a history of PE have an increased risk to develop chronic hypertension and related cardiovascular morbidity and mortality. 2 PE is accompanied by concentric left ventricular remodeling along with diastolic dysfunction and reduced cardiac contractility.3 Accumulating evidence exists that women who experienced PE differ from their counterparts with uneventful pregnancies by persisting abnormal left ventricular geometry and decreased diastolic function.4-6 It may be that former patients with underlying susceptibility for cardiovascular disease (CVD) react to borderline blood pressure values by excessive cardiac remodeling that does not revert to normal after delivery. In this line of reasoning, the slight differences in left ventricular geometry and cardiac diastolic function may be an indication for an increased risk for chronic hypertension as an intermediate condition before later CVD. Therefore, we tested the hypothesis that increased measures of cardiac geometry and decreased cardiac function persisting for ≥6 months postpartum in normotensive women with a history of PE precede the development of later chronic hypertension. Methods Study PopulationThe Maastricht University Medical Center (MUMC) Medical Ethics Committee approved our study protocol before patient enrolment (MEC 0-4-049). Since 1996, we perform postpartum screening ≥4 months postpartum in women who experienced a pregnancy complicated by a hypertensive disorder. The procedures followed were in accordance with institutional guidelines. Informed consent related to the use of clinically acquired data for scientific analysis is standard given at MUMC. Procedures adhere to the principles of the Declaration of Helsinki and Title 45, US Code of Federal Regulations, Part 46, Protection of Human Subjects, Revised November 13, 2001, effective December 13, 2001. For the present study, we included all white primiparous women who were screened postpartum until 2008. PE was diagnosed on the basis of the criteria of the International Society for the Study of Hypertension in Pregnancy.7 Early-onset PE was defined as PE diagnosed before the 34th week of pregnancy. Subjects were scheduled for screening ≥4 weeks after stopping Abstract-Preeclampsia is associated with a 4-fold higher risk for developing remote chronic hypertension. Preeclampsia is accompanied by left ventricular hypertrophy and decreased diastolic function, which may or may not resolve postpartum. We tested the hypothesis that increased measures of cardiac geometry and decreased cardiac function persisting for ≥6 months postpartum in normotensive women with a history of preeclampsia precede the development of later chronic hypertension. Formerly preeclamptic women (n=652) underwent echocardio...

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