In the Journals

Even small BP elevation during pregnancy may predict future hypertension

Elevated blood pressure that still falls below the diagnostic criteria for hypertensive disorders of pregnancy is associated with the development of hypertension 5 years later, according to findings published in Clinical Endocrinology.

Michelle B. Brady

“Those with slight elevations in blood pressure in pregnancy could be flagged for follow-up postpartum for annual blood pressure checks to manage their future hypertension risk,” Michelle B. Brady, BSc, MSc, RD, a registered dietitian with the Perinatal Research Centre at University College Dublin School of Medicine, Ireland, told Endocrine Today. “Further observational studies are needed to confirm the above findings, and clinical trials to determine nonpharmacological interventions, such as changes to dietary pattern, could provide insight into how to manage or reduce future hypertension risk in this female cohort.”

In a prospective, observational study, Brady and colleagues analyzed data from 329 white women who participated in the ROLO study conducted at National Maternity Hospital in Dublin between 2007 and 2011. Researchers assessed maternal BP measurements taken at 13, 28 and 34 weeks’ gestation, 1 day postpartum and again at the 5-year follow-up visit. At each visit, systolic BP and diastolic BP were defined as normal (systolic BP < 120 mm Hg; diastolic BP < 80 mm Hg), elevated (systolic BP between 120-129 mm Hg; diastolic BP < 80 mm Hg), stage 1 hypertension (systolic BP between 130-139 mm Hg; diastolic BP between 80-89 mm Hg) or stage 2 hypertension (systolic BP 140 mm Hg; diastolic BP 90 mm Hg). Primary outcome was maternal BP at 5 years.

At the 5-year follow-up visit, 58.7% had normal BP, 14.6% of women had elevated BP, 18.2% had stage 1 hypertension and 8.5% had stage 2 hypertension.

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Elevated blood pressure that still falls below the diagnostic criteria for hypertensive disorders of pregnancy is associated with the development of hypertension 5 years later.

Researchers found that women with elevated BP at 28 weeks’ gestation were 2.68 times more likely to have stage 1 hypertension at 5 years when compared with women who had normal BP during pregnancy (95% CI, 1.36-5.26). Similarly, elevated BP at 34 weeks’ gestation was associated with a 2.45-fold increase in risk for stage 1 hypertension at 5 years vs. women with normal BP during pregnancy (95% CI, 1.22-4.95). Each 1 mm Hg increase in systolic BP and diastolic BP at 34 weeks’ gestation was associated with 1.04 and 1.05 increased odds, respectively, for the development of stage 1 and stage 2 hypertension at 5-year follow-up. Additionally, each 1 mm Hg increase in mean arterial pressure at 34 weeks’ gestation was associated with 1.05-fold and 1.08-fold increased risk for stage 1 and stage 2 hypertension at 5 years, respectively.

“This research suggests the application of BP thresholds used in nonpregnant populations to pregnant populations to identify those at risk of future hypertension,” the researchers wrote. “Annual BP checks within primary care, following elevated BP at 28 and 34 weeks’ gestation, may help manage such risk. The evidence presented also suggests that mean arterial pressure should routinely be used to evaluate BP in pregnancy.” – by Regina Schaffer

For more information:

Michelle B. Brady, BSc, MSc, RD, can be reached at the Perinatal Research Centre, School of Medicine, University College Dublin, Health Science Center, Roebuck, Ireland; email: michelle.brady.2011@gmail.com.

Disclosures: The authors report no relevant financial disclosures.

Elevated blood pressure that still falls below the diagnostic criteria for hypertensive disorders of pregnancy is associated with the development of hypertension 5 years later, according to findings published in Clinical Endocrinology.

Michelle B. Brady

“Those with slight elevations in blood pressure in pregnancy could be flagged for follow-up postpartum for annual blood pressure checks to manage their future hypertension risk,” Michelle B. Brady, BSc, MSc, RD, a registered dietitian with the Perinatal Research Centre at University College Dublin School of Medicine, Ireland, told Endocrine Today. “Further observational studies are needed to confirm the above findings, and clinical trials to determine nonpharmacological interventions, such as changes to dietary pattern, could provide insight into how to manage or reduce future hypertension risk in this female cohort.”

In a prospective, observational study, Brady and colleagues analyzed data from 329 white women who participated in the ROLO study conducted at National Maternity Hospital in Dublin between 2007 and 2011. Researchers assessed maternal BP measurements taken at 13, 28 and 34 weeks’ gestation, 1 day postpartum and again at the 5-year follow-up visit. At each visit, systolic BP and diastolic BP were defined as normal (systolic BP < 120 mm Hg; diastolic BP < 80 mm Hg), elevated (systolic BP between 120-129 mm Hg; diastolic BP < 80 mm Hg), stage 1 hypertension (systolic BP between 130-139 mm Hg; diastolic BP between 80-89 mm Hg) or stage 2 hypertension (systolic BP 140 mm Hg; diastolic BP 90 mm Hg). Primary outcome was maternal BP at 5 years.

At the 5-year follow-up visit, 58.7% had normal BP, 14.6% of women had elevated BP, 18.2% had stage 1 hypertension and 8.5% had stage 2 hypertension.

#
Elevated blood pressure that still falls below the diagnostic criteria for hypertensive disorders of pregnancy is associated with the development of hypertension 5 years later.

Researchers found that women with elevated BP at 28 weeks’ gestation were 2.68 times more likely to have stage 1 hypertension at 5 years when compared with women who had normal BP during pregnancy (95% CI, 1.36-5.26). Similarly, elevated BP at 34 weeks’ gestation was associated with a 2.45-fold increase in risk for stage 1 hypertension at 5 years vs. women with normal BP during pregnancy (95% CI, 1.22-4.95). Each 1 mm Hg increase in systolic BP and diastolic BP at 34 weeks’ gestation was associated with 1.04 and 1.05 increased odds, respectively, for the development of stage 1 and stage 2 hypertension at 5-year follow-up. Additionally, each 1 mm Hg increase in mean arterial pressure at 34 weeks’ gestation was associated with 1.05-fold and 1.08-fold increased risk for stage 1 and stage 2 hypertension at 5 years, respectively.

“This research suggests the application of BP thresholds used in nonpregnant populations to pregnant populations to identify those at risk of future hypertension,” the researchers wrote. “Annual BP checks within primary care, following elevated BP at 28 and 34 weeks’ gestation, may help manage such risk. The evidence presented also suggests that mean arterial pressure should routinely be used to evaluate BP in pregnancy.” – by Regina Schaffer

For more information:

Michelle B. Brady, BSc, MSc, RD, can be reached at the Perinatal Research Centre, School of Medicine, University College Dublin, Health Science Center, Roebuck, Ireland; email: michelle.brady.2011@gmail.com.

Disclosures: The authors report no relevant financial disclosures.