Hypertension After Preeclampsia Is Preceded by Changes in Cardiac Structure and Function

Ghossein‐Doha, Chahinda; Peeters, Louis L.H.; Heijster, Sanne van; Kuijk, Sander M. J. van; Spaan, Julia J.; Delhaas, Tammo; Spaanderman, Marc E. A.

doi:10.1161/hypertensionaha.113.01319

Cited by 70 publications

(68 citation statements)

References 31 publications

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“…16 Adding the excluded women who remained hypertensive after the preeclamptic index pregnancy (47/386; 12%)) the overall prevalence of hypertension after preeclampsia is comparable with the mean prevalence of 30% to 40% found in other studies in formerly preeclampsia women. 6,[17][18][19][20] Our data show that a substantial proportion of women progressed within a few years from normotension to hypertension.…”

Section: Discussionmentioning

confidence: 55%

Low Plasma Volume in Normotensive Formerly Preeclamptic Women Predisposes to Hypertension

et al. 2015

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P reeclampsia is a serious hypertensive pregnancy disorder complicating 2% to 5% of all pregnancies. Preeclampsia is characterized by hypertension and proteinuria after 20 weeks of gestation. Women with a history of preeclampsia are at increased risk to develop early onset cardiovascular disease (CVD) later in life when compared with women who had an uneventful pregnancy.1 Therefore, in 2011, the American Heart Association added preeclampsia to the list of risk factors for developing CVD.2 The mechanistic explanation for the link between preeclampsia and later CVD remains to be elucidated. 3Numerous studies demonstrated increased prevalence of cardiovascular risk factors after a pregnancy complicated by preeclampsia. [4][5][6] Most formerly preeclampsia women, however, do not demonstrate a traditional cardiovascular risk profile within the first years after preeclampsia.6 Yet, when compared with healthy parous controls, the relative risk of developing chronic hypertension within 15 years after preeclampsia is estimated 3.7 (95% confidence interval, 2.7-5.5).1 This observation indicates that a subset of normotensive formerly preeclampsia women is at risk to develop hypertension within the first years after the affected pregnancy. It is conceivable that these formerly preeclampsia women have subtle or latent abnormalities that could explain the increased cardiovascular risk after pregnancy.Low plasma volume (PV) is considered to reflect latent hypertension, 7 and normotensive formerly preeclampsia women with low PV (LPV) are prone to develop recurrent hypertensive disease in subsequent pregnancy. 8 Whether PV status also relates to chronic hypertension after a pregnancy complicated by preeclampsia has never been studied before. We hypothesized that LPV status in normotensive formerly preeclampsia women predisposes to the development of hypertension. In this longitudinal study, we additionally studied how the traditional cardiovascular and metabolic risk profiles evolve over time after a preeclamptic pregnancy.Abstract-Formerly preeclamptic women are at risk for cardiovascular disease. Low plasma volume may reflect latent hypertension and potentially links preeclampsia with chronic cardiovascular disease. We hypothesized that low plasma volume in normotensive formerly preeclamptic women predisposes to hypertension. We longitudinally studied n=104 formerly preeclamptic women in whom plasma volume was measured 3 to 30 months after the preeclamptic pregnancy. Cardiovascular variables were assessed at 2 points in time (3-30 months postpartum and 2-5 years thereafter). Study population was divided into low plasma volume (≤1373 mL/m 2 ) and normal plasma volume (>1373 mL/m 2 ). Primary end point was hypertension at the second visit: defined as ≥140 mm Hg systolic or ≥90 mm Hg diastolic. Secondary outcome of this study was change in traditional cardiovascular risk profile between visits. Variables correlating univariately with change in blood pressure between visits were introduced in regression analysis. Eighteen of 104 ...

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Section: Discussionmentioning

confidence: 55%

Low Plasma Volume in Normotensive Formerly Preeclamptic Women Predisposes to Hypertension

et al. 2015

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“…Solanki et al [4] and Ghossein Doha et al [5] studied the same parameter in pre-eclamptics and normotensives and found a significant difference in LVEDV between the two groups (108.23 ± 27.95 vs. 107.73 ± 5.66 ml, 100 ± 16 vs. 94 ± 7 ml).…”

Section: Discussionmentioning

confidence: 96%

“…Ghossein Doha et al [5] studied systolic parameters in 40 pre-eclamptic women and 40 normotensive women and concluded that the mean LVEDV was higher in preeclamptic group, i.e. (100 ± 16 vs. 94 ± 7 ml), highlighting the importance of this variable in early detection of cardiovascular morbidity.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Echocardiographic Systolic Parameters in Pre-Eclamptics and Normotensives Women

Jain

Verma

Rajoria

2016

J Obstet Gynecol India

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Objective Early detection of changes in cardiovascular echocardiographic systolic parameters and their comparison with normotensives women. Methods This was a hospital-based prospective casecontrol study carried out in Department of Obstetrics and Gynaecology in S.M.S Medical College, Jaipur, during the period from February 2013 to December 2014. In total, 100 women were enrolled in the study after applying inclusion and exclusion criteria. All women underwent two-dimensional echocardiography at rest. Cardiac systolic parameters were recorded and studied. Results Mean LVEDV in the PIH group was 75.71 ± 4.8 versus 71.08 ± 5.6 ml in the control group, and the difference was statistically significant. Mean stroke volume was higher in the PIH group as compared to the control group, and the difference was statistically significant (59.83 ± 7.4 vs. 52.48 ± 6.4 ml/min). Mean aortic root diameter in the PIH group was 2.188 ± 1.04 cm as compared to the 1.866 ± 1.06 cm in the control group which was statistically significant. Mean left ventricular outflow tract diameter was slightly higher in the PIH group as compared to the controls although the P value was not significant (2.37 ± 1.06 and 1.99 ± 1.08 cm). Mean total vascular resistance was found to be higher in the PIH group 123 as compared to the controls, and the difference was statistically significant (1389 ± 57.04 vs. 1286 ± 45.01 dynes/sec/cm -5 ).Conclusion Systolic parameters get worsened in preeclamptics. Early detection of change in these parameters could help to identify high-risk women who are prone to develop cardiovascular morbidity in later life.

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“…6 Increased preload, in conjunction with the decreased peripheral resistance, leads to an increase in cardiac output. These physiologic changes lead to left ventricular remodeling and mild left ventricular hypertrophy.…”

Section: Echocardiographymentioning

confidence: 99%

“…Pregnant women with preeclampsia and multiple gestation exhibit additional increase in left ventricular mass. 6 Regional wall motion abnormalities (RWMA) are not seen in normal pregnancy, and if observed, indicate myocardial ischemia or injury. 7 This finding is especially helpful in the setting of equivocal ECG changes, when RWMA not only serves as diagnostic guides, but also as prognostic indicators for further cardiac events.…”

Section: Echocardiographymentioning

confidence: 99%

ST‐elevation acute myocardial infarction in pregnancy: 2016 update

Ismail

Wong

Rajan

et al. 2017

Clinical Cardiology

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Acute myocardial infarction (AMI) during pregnancy or the early postpartum period is rare, but can be devastating for both the mother and the fetus. There have been major advances in the diagnosis and treatment of acute coronary syndromes in the general population, but there is little consensus on the approach to diagnosis and treatment of pregnant women. This article reviews the literature relating to the pathophysiology of AMI in pregnant patients and the challenges in diagnosis and treatment of ST-elevation myocardial infarction (STEMI) in this unique population. From a cardiologist, maternal-fetal medicine specialist, and anesthesiologist's perspective, we provide recommendations for the diagnosis and management of STEMI occurring during pregnancy.

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Hypertension After Preeclampsia Is Preceded by Changes in Cardiac Structure and Function

Cited by 70 publications

References 31 publications

Low Plasma Volume in Normotensive Formerly Preeclamptic Women Predisposes to Hypertension

Low Plasma Volume in Normotensive Formerly Preeclamptic Women Predisposes to Hypertension

Evaluation of Echocardiographic Systolic Parameters in Pre-Eclamptics and Normotensives Women

ST‐elevation acute myocardial infarction in pregnancy: 2016 update

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