Hypertensive disorders of pregnancy impact heart structure, function over time
Women with hypertensive disorders of pregnancy or hypertension after pregnancy had significant differences in left ventricular structure and function over time, researchers reported.
“Although there has been some characterization of structural cardiac changes among women with a history of [hypertensive disorders of pregnancy], the underlying mechanisms for these changes are incompletely understood,” Malamo E. Countouris, MD, clinical instructor of cardiology at the University of Pittsburgh Medical Center Heart and Vascular Institute, and colleagues wrote in the Journal of the American College of Cardiology.
Researchers selected 132 women (mean age, 38 years) who gave birth from 2008 to 2009 from a clinical cohort with pregnancy and placental pathology data to undergo transthoracic echocardiography from 2017 to 2020. At the study visit, medical history, BP and weight for each participant were obtained.
In the cohort, 102 participants had normotensive pregnancies and 30 had hypertensive disorders of pregnancy (HDP) — 21 with preeclampsia and nine with gestational hypertension. Women with HDP were more likely to have current hypertension (63% vs. 26%; P < .001) compared with women with normotensive pregnancies.
Women with a history of HDP demonstrated higher interventricular septal thickness (beta = 0.08) and relative wall thickness (beta = 0.04; P = .04 for both) after adjustment for other confounders. Higher proportions of LV remodeling were observed among 79% of women with HDP and current hypertension in the subgroup analysis compared with women with HDP only (36.4%; P = .01), current hypertension only (46.2%; P = .02) and neither hypertensive disorders of pregnancy nor hypertension (38.2%; P < .001).
Placental maternal vascular malperfusion did not impact the findings.
According to a press release from the University of Pittsburgh, the researchers suggest more studies are needed to clarify the cause-and-effect relationship between women with a complicated pregnancy and long-term effects on the heart.
“[These results] suggests a ‘double-hit’ phenomenon of HDP history and current hypertension warranting closer surveillance an early and targeted therapies for CVD prevention in this higher-risk group,” the researchers wrote.
In an accompanying editorial, Melinda B. Davis, MD, cardiologist in the department of medicine in the division of cardiovascular medicine at the University of Michigan, Ann Arbor, noted that the findings highlight the importance of early CVD risk identification.
However, researchers could have underestimated hypertension prevalence in the cohort by relying on office readings and medical history as undertreatment of hypertension also contributed to adverse cardiac remodeling over time, particularly among women, Davis wrote.
“[This study] advances our understanding of HDP and the subsequent risk for cardiac remodeling within 10 years postpartum,” Davis wrote. “Future research is needed to better understand the pathophysiologic mechanisms and the optimal delivery of care; in parallel, we need to rigorously diagnose and treat hypertension and other CVD risk factors in young women with prior HDP.”