Variations in Cardiovascular Structure, Function, and Geometry in Midlife Associated With a History of Hypertensive Pregnancy

Boardman, Henry; Lamata, Pablo; Lazdam, Merzaka; Verburg, Ashley; Siepmann, Timo; Upton, Ross; Bilderbeck, Amy C.; Dore, Rhys; Smedley, Clare; Kenworthy, Yvonne; Sverrisdóttir, Yrsa Bergmann; Aye, Christina; Williamson, Wilby; Huckstep, O J; Francis, Jane M; Neubauer, Stefan; Lewandowski, Adam J.; Leeson, Paul

doi:10.1161/hypertensionaha.119.14530

Cited by 45 publications

(31 citation statements)

References 47 publications

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“… 40 , 41 Persistence of left ventricular hypertrophy at 1 year postpartum in women with preterm preeclampsia was strongly associated with risk of developing essential hypertension within the subsequent 2 years. 38 , 42 We have previously described left ventricular hypertrophy, diastolic dysfunction, capillary rarefaction, and reduced aortic compliance 17 at 5 to 10 years following a hypertensive pregnancy, compared with a normotensive pregnancy. We hypothesize that the long-term improvements in BP we have observed may reflect a regression of this adverse remodeling and are currently testing this hypothesis in the Physician Optimised Post-Partum Hypertension Treatment Trial ( https://clinicaltrials.gov/ct2/show/NCT04273854 ).…”

Section: Discussionmentioning

confidence: 99%

Short-Term Postpartum Blood Pressure Self-Management and Long-Term Blood Pressure Control: A Randomized Controlled Trial

et al. 2021

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Women with hypertensive pregnancies are 4× more likely to develop chronic hypertension. Previously, we showed a short period of blood pressure (BP) self-management following hypertensive pregnancy resulted in persistently lower BP after 6 months. We now report the impact on long-term BP control. Women who participated in the postpartum randomized controlled trial, SNAP-HT (Self-Management of Postnatal Hypertension; NCT02333240), were invited for 24-hour ambulatory and clinic BP measures. Height and weight were measured by calibrated scales and standardized tape measures, activity by 7-day wrist-worn accelerometer, and dietary factors assessed by questionnaire. Sixty-one of 70 eligible women were followed up 3.6±0.4 years after their original pregnancy. Twenty-four–hour diastolic BP was 7.0 mm Hg lower in those originally randomized to postpartum BP self-management instead of usual care. This difference remained significant after adjustment for either BP at the time of delivery (−7.4 mm Hg [95% CI, −10.7 to −4.2]; P <0.001) or pregnancy booking BP (−6.9 mm Hg [95% CI, −10.3 to −3.6]; P <0.001). Adjustment for current salt intake, age, body mass index, waist-to-hip ratio, arm circumference, parity, alcohol intake, and physical activity had no effect on this difference. Reductions in diastolic BP at 6 months, following self-management of BP postpartum, are maintained 3.6 years later as measured by lower 24-hour diastolic BP. Interventions to optimize BP control during the puerperium in women with hypertensive pregnancies improve BP in the longer term, in a cohort at increased risk of developing chronic hypertension and major adverse cardiovascular events. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02333240.

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Section: Discussionmentioning

confidence: 99%

Short-Term Postpartum Blood Pressure Self-Management and Long-Term Blood Pressure Control: A Randomized Controlled Trial

et al. 2021

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“… 27 Women with a history of HDP have persistent structural differences in the heart and microvasculature more than 25 years after their pregnancy. 28 , 29 Women with a history of HDP have increased echocardiographic diastolic parameters, including left ventricular mass index, increased relative wall thickness, lower impaired relaxation (ie, lower transmitral Doppler E/A ratio), and higher left ventricular filling pressure (ie, E/e′ ratio) in comparison with those with a history of normotensive pregnancies, all of which are associated with HF. 28 , 30 , 31 Women with HDP also have impaired coronary flow reserve, which is a key feature of HFpEF.…”

Section: Discussionmentioning

confidence: 99%

Adverse Pregnancy Outcomes and Incident Heart Failure in the Women’s Health Initiative

et al. 2021

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Key Points Question Are adverse pregnancy outcomes independently associated with the development of heart failure among postmenopausal women? Findings In this cohort study including 10 292 Women’s Health Initiative participants, hypertensive disorders of pregnancy were independently associated with incident heart failure, particularly heart failure with preserved ejection fraction, in postmenopausal women. Meaning These findings suggest that hypertensive disorders of pregnancy are sex-specific factors associated with risk of heart failure, particularly heart failure with preserved ejection fraction.

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“…A mechanism found in both PPCM and preeclampsia is endothelial dysfunction with reduced vascular endothelial growth factor (VEGF; Gennari-Moser et al, 2013;Goland et al, 2016). Hypertensive pregnancies may result in increased aortic stiffness and microvascular rarefaction persisting 5-10 years after (Boardman et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Increased arterial stiffness and reduced left ventricular long‐axis function in patients recovered from peripartum cardiomyopathy

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et al. 2020

Clin Physio Funct Imaging

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Background Peripartum cardiomyopathy (PPCM) is idiopathic pregnancy‐associated heart failure (HF) with reduced left ventricular ejection fraction (LVEF). We aimed to assess arterial stiffness and left ventricular (LV) function in women recovered from PPCM compared with controls. Methods Twenty‐two PPCM patients were compared with 15 age‐matched controls with previous uncomplicated pregnancies. Eleven of the patients were at inclusion in the study recovered and off medication since at least 6 months and still free from cardiovascular symptoms with normal LVEF and normal NT‐proBNP. All underwent echocardiography, including LV strain, left atrial (LA) reservoir strain and tissue Doppler early diastolic velocity (e´) and non‐invasive assessment for arterial stiffness and central aortic systolic blood pressure (AoBP) at rest and immediately postexercise. Results The patients off medication showed alterations compared with controls. AoBP was higher (120 ± 9 mm Hg vs. 104 ± 13 mm Hg; p = .001), a difference which persisted postexercise. The arterial elastance was higher (1.9 ± 0.4 mm Hg/ml vs. 1.3 ± 0.2 mm Hg/ml; p < .001), while there were lower e´ septal (8.9 ± 1.7 cm/s vs. 11.0 ± 1.1 cm/s; p = 0. 002), LV global strain (18.7 ± 3.9% vs. 23.1 ± 1.6%; p = .004) and LA reservoir strain (24.8 ± 9.1% vs. 37.7 ± 6.3%; p = .002). Conclusions Compared with healthy controls, PPCM patients considered recovered and off medication had increased arterial stiffness, decreased LV longitudinal function and reduced LA function.

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Variations in Cardiovascular Structure, Function, and Geometry in Midlife Associated With a History of Hypertensive Pregnancy

Abstract: Supplemental Digital Content is available in the text.

Cited by 45 publications

References 47 publications

Short-Term Postpartum Blood Pressure Self-Management and Long-Term Blood Pressure Control: A Randomized Controlled Trial

Short-Term Postpartum Blood Pressure Self-Management and Long-Term Blood Pressure Control: A Randomized Controlled Trial

Adverse Pregnancy Outcomes and Incident Heart Failure in the Women’s Health Initiative

Increased arterial stiffness and reduced left ventricular long‐axis function in patients recovered from peripartum cardiomyopathy

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