In recent years, gestational hypertension, defined in accordance with the classification of the European Society of Cardiology (2011) as hypertension induced by pregnancy, occurring with or without proteinuria, developing after 20 weeks of pregnancy and resolving up to 42 days after delivery, is considered as a adverse prognostic factor in respect of development of cardiovascular diseases in the future and cardiovascular mortality. This review presents the results of various studies on the relationship of history of gestational hypertension with risk factors for cardiovascular disease, target organ damage, associated clinical conditions and cardiovascular risk in women, including those of reproductive age. Determination of the individual cardiovascular risk in women, especially in young women, is difficult due to the low sensitivity and specificity of the tests in this category of patients. In spite of the conducted studies and obtained experience regarding issues on the relationship of history of hypertension during pregnancy with cardiovascular risk, until now the origin and the contribution of the various forms of hypertensive disorders during pregnancy, including gestational hypertension, to the development of future cardiovascular disease is still unclear. Detection of the history of gestational hypertension will allow to more accurately assess the individual cardiovascular risk and administer an adequate range of therapeutic and preventive measures for women, including those of reproductive age, at an earlier stage.
This review presents the results of various studies on the problem of cardiovascular events and the risk of their development as well as long-term mortality in young patients with cerebrovascular accidents or strokes. In recent decades, there has been a tendency to rejuvenation of cerebrovascular diseases often leading to fatal outcomes. At present, the question of the course of stroke in the acute stage of the disease is most studied. Meanwhile, the study of late, including long-term (5years or more) results of the stroke is important for planning the organization of medical care using the principles of evidence-based medicine. The long-term prognosis for young patients who underwent strokes is of particular interest from a medical and social point of view due to the increase of life expectancy and basic responsibilities at a difficult stage of life. According to a meta-analysis carried out on the results of prospective studies, it was found that the prognosis of a young stroke is not as favorable as it was previously thought with respect to the development of cardiovascular diseases or psychosocial consequences as well as mortality. It was shown that the risk of death among young patients aged 18 to 49years who survived a 30-day primary stroke, compared to the risk of death in the general population, remained increased even after 15years. However, this issue remains still insufficiently studied. Further research is needed in this area.
Aim. To assess the cardiovascular risk in women of reproductive age, depending on the presence of gestational arterial hypertension in the anamnesis. Methods. Examined were 25 practically healthy volunteers with normal blood pressure, 33 patients with high normal blood pressure and 77 women with arterial hypertension (Classification of the All-Russian Scientific Society of Cardiologists, 2010) with a history of arterial hypertension of 0.5-24 years. The average age of patients with arterial hypertension was 40.8±4.5 years. All examined individuals were divided into two groups depending on the presence of gestational arterial hypertension. Determined were the group averages and grades (in percent) of the studied factors. Results. Among women of the reproductive age gestational arterial hypertension was significantly more common in patients with arterial hypertension compared to women with normal levels of blood pressure (62.3 vs. 16%, p 0.001 by χ2 criteria). In the group of patients with arterial hypertension who have gestational arterial hypertension, compared with those individuals with normal blood pressure, who have gestational arterial hypertension significantly more ofter (p 0.05, Fisher’s exact test) seen was the abdominal type of obesity (54.1 vs. 0%). In the group of patients with arterial hypertension who have gestational arterial hypertension, compared with individuals with normal blood pressure without gestational arterial hypertension significantly more often (Fisher’s exact test) recorded was a family history of cardiovascular disease (inxcluding arterial hypertension), obesity, especially the abdominal type; revealed were significantly (by the U criteria) higher mean values of waist circumference, waist circumference relationship to hip circumference, body mass index, total cholesterol level. A significantly (p 0.01, Fisher’s exact test) greater proportion of individuals with very high additional risk of developing complications of hypertension in the next 10 years was noted in the group of patients with arterial hypertension and gestational arterial hypertension compared to patients with high normal blood pressure and gestational hypertension (37.5 vs. 0%). Conclusion. In women of reproductive age gestational arterial hypertension is a specific risk factor for subsequent arterial hypertension that is associated with significantly greater frequency of obesity, especially the abdominal type, very high additional risk of complications of arterial hypertension, as well as significantly higher mean values of waist circumference, ratio of waist circumference / hip circumference, and total cholesterol level.
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