Twenty-Four-Hour Blood Pressure Variability Is Associated With Lower Cognitive Performance in Young Women With a Recent History of Preeclampsia

Abstract

Background Women with a history of preeclampsia (hxPE) exhibit sustained arterial stiffness and elevated blood pressure (BP) postpartum. Aortic stiffness and 24-hour BP variability (BPV) are associated with age-related cognitive decline. Although hxPE is related to altered cognitive function, the association between aortic stiffness and BPV with cognitive performance in young women with hxPE has not been investigated. The objectives of this study were to 1) test whether cognitive performance is lower in young women with hxPE and 2) determine whether aortic stiffness and BPV are associated with cognitive performance independent of 24-hour average BP. Methods Women with hxPE (N=23) and healthy pregnancy controls (N=38) were enrolled 1-3 years postpartum. Cognitive performance was assessed in domains of memory, processing speed and executive function. 24-hour ambulatory BP monitoring and carotid-femoral pulse wave velocity (cfPWV) were used to measure BPV and aortic stiffness, respectively. Results Women with hxPE had slower processing speed (-0.56±0.17 versus 0.34±0.11 Z-score, P<0.001) and lower executive function (-0.43±0.14 versus 0.31±0.10 Z-score, P=0.004) compared with controls independent of education, whereas memory did not differ. BPV and cfPWV (adjusted for BP) did not differ between women with hxPE and controls. Greater diastolic BPV was associated with lower executive function independent of 24-hour average BP and education in women with hxPE (r = -0.48, P=0.03) but not controls (r = 0.15, P=0.38). Conclusions Select cognitive functions are reduced postpartum in young women with a recent hxPE and linked with elevated 24-hour diastolic BPV.

Pre-eclampsia

“…Within pre-eclampsia groups, women who have had early-onset pre-eclampsia have a higher burden of kidney disease than women with late-onset pre-eclampsia 297 . Pre-eclampsia also leads to long-term cognitive dysfunction 301,302 and neurological complications, including stroke 303 , cerebral white matter lesions 304,305 and posterior reversible encephalopathy syndrome 306 . Compared with late-onset pre-eclampsia, some of the neurological symptoms are more common in early-onset preeclampsia 304 .…”

Risk of future cardiovascular diseases in different years postpartum after hypertensive disorders of pregnancy: A systematic review and meta-analysis

“…These studies were conducted in Europe (27 studies), [ 35 , 39 , 40 , 42 , 45 , 46 , 48 , 50 , 52 , 54 – 57 , 60 , 61 , 64 , 66 , 68 , 70 , 73 , 76 , 79 , 82 – 84 , 88 , 92 ] North America (14 studies), [ 34 , 36 – 38 , 51 , 53 , 58 , 59 , 65 , 69 , 72 , 77 , 81 , 87 ] Asia (12 studies), [ 41 , 47 , 49 , 62 , 63 , 67 , 71 , 74 , 78 , 80 , 89 , 90 ] and other regions of the world. [ 43 , 44 , 75 , 85 , 86 , 91 ] The study design of the studies included was the retrospective cohort for 36 of them [ 34 , 35 , 37 , 38 , 41 , 44 , 46 , 49 , 52 – 56 , 63 – 68 …”

“…[ 43 , 44 , 75 , 85 , 86 , 91 ] The study design of the studies included was the retrospective cohort for 36 of them [ 34 , 35 , 37 , 38 , 41 , 44 , 46 , 49 , 52 – 56 , 63 – 68 , 70 – 72 , 74 , 76 – 82 , 85 , 87 – 90 , 92 ] and the prospective cohort for the remaining 23 studies. [ 36 , 39 , 40 , 42 , 43 , 45 , 47 , 48 , 50 , 51 , 57 – 62 , 69 , 73 , 75 , 83 , 84 , 86 , 91 ] In 23 studies, only women with preeclampsia were included [ 36 , 38 – 40 , 44 – 48 , 50 , 59 – 61 , 66 , 67 , 71 , 74 , 76 , 82 , 84 – 87 ] and the other 36 studies included women with gestational hypertension and preeclampsia. [ 34 , 35 , 37 , 41…”

“…[ 36 , 39 , 40 , 42 , 54 , 55 , 58 , 72 , 80 ] Only 21 studies clearly showed the adjustment for both key confounding factors (age, smoking, and body mass index) and other factors, [ 37 , 38 , 43 , 45 , 51 , 53 , 54 , 56 , 57 , 59 , 61 , 64 , 68 , 69 , 73 , 77 , 81 , 84 , 88 , 89 , 91 ] while 8 studies did not adjust for any factors. [ 44 , 50 , 60 , 71 , 85 – 87 , 92 ] Adequate follow-up duration was reported in 27 studies. Data regarding completeness of follow-up were unavailable in 25 studies [ 37 , 38 , 43 , 44 , 46 , 49 – 51 , 53 , 54 , 56 , 57 , 59 , 60 , 63 , 65 – 68 , 72 , 76 , 78 , 88 , 90 , 91 ] and 7 of them had follow-up rates that were <80%.…”

“…Ntlemo, 2021 [86] South Africa Prospective cohort Preeclampsia 150 163 NS Hypertension Nuckols, 2021 [87] United States Retrospective cohort Preeclampsia 23 38 1.5 (mean) Hypertension Oliver-Williams, 2022 [88] United Kingdom Retrospective cohort Gestational hypertension, preeclampsia 159,819 2,199,567 NS Cardiovascular diseases, stroke, myocardial infarction, heart failure, cardiomyopathy, cardiac arrhythmia Park, 2022 [89] Korea Retrospective cohort Gestational hypertension, preeclampsia or eclampsia 37,297 1,998,387 NS Cardiac arrhythmia…”