Prevalence of Hypertensive Phenotypes After Preeclampsia

Ditisheim, Agnès; Wuerzner, Grégoire; Ponte, Belén; Vial, Yvan; Irion, Olivier; Burnier, Michel; Boulvain, Michel; Péchère-Bertschi, Antoinette

doi:10.1161/hypertensionaha.117.09799

Cited by 62 publications

(55 citation statements)

References 43 publications

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“…The BP fails to normalise post-partum in some women. The study in women with a history of PE demonstrated HT in 24% of women, white coat HT in 18% of women and masked HT in 9.5% of women assessed with 24-hour BP monitoring at 6-12 weeks following delivery [219]. It also demonstrated that older age, earlier onset and longer duration of gestational HT were associated with persistent BP elevation postpartum in women with a history of gestational HT [220].…”

Section: The Risk Of Hypertension In Women With a History Of Gestatiomentioning

confidence: 85%

Management of hypertension in pregnancy — prevention, diagnosis, treatment and long-term prognosis. A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians

Prejbisz¹,

Dobrowolski²,

Kosiński³

et al. 2019

Arterial Hypertension

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Disclaimer: The position statement represent the views of the authors and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating. The authors and societies are not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the position statement and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the position statement fully into account when exercising their clinical judgment as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies. 118 www.ah.viamedica.pl ABPM -ambulatory blood pressure monitoring ACE-I -angiotensin-converting enzyme inhibitor AF -atrial fibrillation AFI -amniotic fluid index AFL -atrial flutter AGA -appropriate for gestational age AHI -apnea hypopnea index AKI -acute kidney injury ALT -alanine transaminase ARB -angiotensin receptor blocker ARR -aldosterone-to-renin ratio AST -aspartate aminotransferase AT -atrial tachycardia BAV -bicuspid aortic valve BMI -body mass index BNP -B-nariuretic peptide BP -blood pressure Bpm -beats per minute BPP -biophysical profile CABG -coronary artery bypass graft CAD -coronary artery disease CKD -chronic kidney disease CNS -central nervous system CoA -coarctation of the aorta CPAP -continuous positive airway pressure CPR -cerebroplacental ratio CTG -cardiotocography CV -cardiovascular DBP -diastolic blood pressure DIC -disseminated intravascular coagulation DM -diabetes mellitus ECMO -extracorporeal membrane oxygenation ECG -electrocardiography EF -ejection fraction ESC -European Society of Cardiology ESH -European Society of Hypertension EVA -early vascular ageing FDA -Food and Drug Administration FHR -foetal heart rate FIGO -International Federation of Gynaecology and Obstetrics FMD -fibromuscular dysplasia FMF -Fetal Medicine Foundation FPS -frame per second GFR -glomerular filtration rate HELLP -hemolysis, elevated liver enzymes, low platelet countuterine growth restriction IVF -in vitro fertilisation LBBB -left bundle branch block LBW -low birth weight LDH -lactate dehydrogenase LQTS -long QT syndrome LVAD -left ventricular assist device LVEF -left ventricular ejection fraction MAP -mean arterial pressure MCA -middle cerebral artery MCS -mechanical circulatory support MDT -multidisciplinary team MRA -mineralocorticoids renceptor antagonist MRAs -mineralocorticoids renceptor antagonists MRI -magnetic resonance imaging NSTEMI -non-ST elevation myocardial infarction NT-BNP -N-terminal pro-BNP NTS -non-stress-test OGTT -oral glucose tolerance test OSA -obstructive sleep apnoea p.o. -per os PA -primary aldosteronism PAPP-A -pregnancy associated placental protein PCI -percutaneous coronary intervention PE -pre-eclampsia PI -pulsatility index PlGF -placental growth factor PPCM -peripartum cardiomyopathy PPGL -pheochromocytoma a...

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Section: The Risk Of Hypertension In Women With a History Of Gestatiomentioning

confidence: 85%

Management of hypertension in pregnancy — prevention, diagnosis, treatment and long-term prognosis. A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians

Prejbisz¹,

Dobrowolski²,

Kosiński³

et al. 2019

Arterial Hypertension

View full text Add to dashboard Cite

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“…Fifteen studies were included in the systematic review after assessing 223 articles in full text with respect to their eligibility for inclusion from the 8407 articles identified through the search (Figure 1, Tables S1 and S2). 10,[20][21][22][23][24][25][26][27][28][29][30][31][32][33] Among these studies, 14/15 were cohort studies and 1/15 was a case-control study. The total population sample size ranged from 28 to 5105 patients and follow up from 2 to 24 months postpartum.…”

Section: General Characteristicsmentioning

confidence: 99%

“…Four studies included women with chronic hypertension pre-dating the index pregnancy, 22,23,26,30 and three of four provided the outcome data without these cases. 22,23,30 In 11 studies the authors reported the technique of blood pressure measurement: in 4 studies, hypertension was diagnosed using a standard sphygmomanometer, 10,20,25,33 and in seven 11, an automatic device was employed. 21,22,24,27,28,31,32 In addition, in one study the incidence of hypertension was self-reported by patients using a standardised questionnaire.…”

Section: General Characteristicsmentioning

confidence: 99%

Incidence of postpartum hypertension within 2 years of a pregnancy complicated by pre‐eclampsia: a systematic review and meta‐analysis

Giorgione

Ridder

Kalafat

et al. 2020

BJOG

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Background Women with a history of hypertensive disorders of pregnancy (HDP) are at increased long-term risk of cardiovascular disease. However, there has been increasing evidence on the same risks in the months following birth. Objectives This review aims to estimate the incidence of hypertension in the first 2 years after HDP. Search strategy MEDLINE, Embase and Cochrane databases were systematically searched in October 2019. Selection criteria Observational studies comparing hypertension rate following HDP and normotensive pregnancies up to 2 years. Data collection and analysis A meta-analysis to calculate the odds ratio (OR) with a 95% confidence interval (CI) and a subgroup analysis excluding women with chronic hypertension were performed. Main results Hypertension was diagnosed within the first 2 years following pregnancy in 468/1646 (28.4%) and 584/6395 (9.1%) of the HDP and control groups, respectively (OR 6.28; 95% CI 4.18-9.43; I 2 = 56%). The risk of hypertension in HDP group was significantly higher in the first 6 months following delivery (OR 18.33; 95% CI 1.35-249.48; I 2 = 84%) than at 6-12 months (OR 4.36; 95% CI 2.81-6.76; I 2 = 56%) or between 1-2 years postpartum (OR 7.24; 95% CI 4.44-11.80; I 2 = 9%). A subgroup analysis demonstrated a similar increase in the risk of developing postpartum hypertension after HDP (OR 5.75; 95% CI 3.92-8.44; I 2 = 49%) and pre-eclampsia (OR 6.83; 95% CI 4.25-10.96; I 2 = 53%). Conclusions The augmented risk of hypertension after HDP is highest in the early postpartum period, suggesting that diagnosis and targeted interventions to improve maternal cardiovascular health may need to be commenced in the immediate postpartum period.

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“…A history of PE increases the mother's CV risk to a magnitude similar to that of diabetes. A recent prospective cohort study found increased frequency of persistent hypertension after PE . Bearing in mind that PE has been included as a risk factor for CV disease by the AHA, women who have had PE should be followed by a cardiologist.…”

Section: Long‐term Risk For Mother and Childmentioning

confidence: 99%

Hypertension in pregnancy: Taking cues from pathophysiology for clinical practice

Sava

March

Pepine

2018

Clinical Cardiology

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Pregnancy-related hypertension (PHTN) syndromes are a frequent and potentially deadly complication of pregnancy, while also negatively impacting the lifelong health of the mother and child. PHTN appears in women likely to develop hypertension later in life, with the stress of pregnancy unmasking a subclinical hypertensive phenotype. However, distinguishing between PHTN and chronic hypertension is essential for optimal management. Preeclampsia (PE) is linked to potentially severe outcomes and lacks effective treatments due to poorly understood mechanisms. Inadequate remodeling of spiral uterine arteries (SUAs), the cornerstone of PE pathophysiology, leads to hypoperfusion of the developing placenta. In normal pregnancies, extravillous trophoblast (EVT) cells assume an invasive phenotype and invade SUAs, transforming them into large conduits. Decidual natural killer cells play an essential role, mediating materno-fetal immune tolerance, inducing early SUA remodeling and regulating EVT invasiveness. Notch signaling is important in EVT phenotypic switch and is dysregulated in PE. The hypoxic placenta releases antiangiogenic and proinflammatory factors that converge upon maternal endothelium, inducing endothelial dysfunction, hypertension, and organ damage.Hypoxia-inducible factor 1-α is upstream of such molecules, whereas endothelin-1 is a major effector. We also describe important genetic links and evidence of incomplete materno-fetal immune tolerance, with PE patients presenting with autoantibodies, lower T reg , and higher T h 17 cells. Thus, PE manifestations arise as a consequence of mal-placentation or/and because of a predisposition of the maternal vascular bed to excessively react to pathogenic molecules.From this pathophysiological basis, we provide current and propose future therapeutic directions for PE.

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Prevalence of Hypertensive Phenotypes After Preeclampsia

Abstract: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01095939.

Cited by 62 publications

References 43 publications

Management of hypertension in pregnancy — prevention, diagnosis, treatment and long-term prognosis. A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians

Management of hypertension in pregnancy — prevention, diagnosis, treatment and long-term prognosis. A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians

Incidence of postpartum hypertension within 2 years of a pregnancy complicated by pre‐eclampsia: a systematic review and meta‐analysis

Hypertension in pregnancy: Taking cues from pathophysiology for clinical practice

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