Clinical Implications

Abstract

HomeHypertensionVol. 75, No. 1Clinical Implications Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBClinical Implications Originally published11 Dec 2019https://doi.org/10.1161/HYPERTENSIONAHA.119.14339Hypertension. 2020;75:2is related toImportance of Early Diagnosis in Peripartum CardiomyopathyMicrovascular Dysfunction Is Associated With Worse Cognitive PerformanceHigh Blood Pressure in Young Adult Survivors Born Extremely Preterm or Extremely Low Birthweight in the Post Surfactant EraHigh Blood Pressure in Young Adults Born Preterm (page 211)Download figureDownload PowerPointInfants who were born extremely preterm (EP; <28 weeks’ gestation) or extremely low birthweight (ELBW; <1000 g) are now surviving into adulthood in increasing numbers. In our study, young adults born EP/ELBW in the early 1990s had substantially elevated blood pressure at 25 years of age compared with controls (>2499 g at birth), with higher proportions in the hypertensive range. Importantly, blood pressure increased more in the EP/ELBW group between 18 and 25 years compared with controls. Our findings have several important clinical implications. Health care professionals, families of EP/ELBW infants, and the survivors themselves should all be aware of the increased risk for high blood pressure in those born EP/ELBW. Taking a complete perinatal history, including gestational age and birthweight, and offering blood pressure measurements, along with advocating for a healthy lifestyle, are recommended when patients born EP/ELBW present for a health check-up. An early, simple proactive approach in the timely identification and control of high blood pressure may lead to improved long-term cardiovascular outcomes in this rapidly growing at-risk population of young adults.Microvascular Damage May Impair Cognitive Function (page 237)Download figureDownload PowerPointCognitive impairment and dementia are major health problems and their prevalence rises with the aging of the population. The mechanisms underlying cognitive impairment remain, however, incompletely understood, and may include microvascular dysfunction and damage. The microvasculature is involved in the regulation of many cerebral processes, notably neurovascular coupling, cerebral autoregulation, and blood-brain barrier permeability. Impairment of these processes may lead to neuronal dysfunction and contribute to cognitive decline. However, evidence for an association between microvascular dysfunction and worse cognitive performance is limited. We therefore used cross-sectional data from the large population-based Maastricht Study to test whether microvascular dysfunction is associated with worse cognitive function. Measures of microvascular dysfunction included magnetic resonance imaging features of cerebral small vessel disease, plasma biomarkers of microvascular dysfunction, albuminuria, flicker light-induced retinal arteriolar and venular dilation response and heat-induced skin hyperemia. These measures were summarized into a microvascular dysfunction composite score. Cognitive domains assessed were memory, processing speed, and executive function. The results showed an association between microvascular dysfunction and worse cognitive performance independent of a large set of potential confounders. These findings support the hypothesis that microvascular dysfunction contributes to the development of cognitive impairment and suggest that microvascular dysfunction may be a target for prevention strategies of cognitive impairment. Future longitudinal studies are needed to further evaluate the association of microvascular dysfunction and cognitive decline and dementia.Early Diagnosis and PPCM Recovery (page 91)Download figureDownload PowerPointPeripartum cardiomyopathy (PPCM) is an often severe form of cardiomyopathy diagnosed towards the end of pregnancy or in the months after delivery. Most women will recover, however, a significant percentage experience persistent cardiomyopathy. Hypertensive disorders of pregnancy (HDP) such as preeclampsia are one of the strongest risk factors for PPCM and share a common pathophysiological mechanism. The rapid resolution of angiogenic imbalance in preeclampsia may lead to faster recovery in women with HDP and PPCM but controversy remains on whether HDP predict a favorable outcome. Timing of diagnosis and race may confound this relationship, as black women are more likely to be diagnosed with HDP, less likely to recover, and more likely to be diagnosed later in the postpartum period. In this single-center study of 220 women with PPCM, patients with HDP were diagnosed earlier postpartum than patients without HDP, an effect that was most pronounced in nonblack patients. Hypertensive disorders of pregnancy were not associated with improved recovery rates. In contrast, early diagnosis (<1-month postpartum) was associated with improved recovery compared to women diagnosed later in the postpartum period. These findings were consistent among black and nonblack women. Notably, women diagnosed early had less severe LV dysfunction, which likely explains the association between early diagnosis and improved outcomes. Improving the early diagnosis of PPCM in at-risk women may improve clinical outcomes in traditionally underserved populations. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesImportance of Early Diagnosis in Peripartum CardiomyopathyJennifer Lewey, et al. Hypertension. 2020;75:91-97Microvascular Dysfunction Is Associated With Worse Cognitive PerformanceSytze P. Rensma, et al. Hypertension. 2020;75:237-245High Blood Pressure in Young Adult Survivors Born Extremely Preterm or Extremely Low Birthweight in the Post Surfactant EraAnjali Haikerwal, et al. Hypertension. 2020;75:211-217 January 2020Vol 75, Issue 1 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.119.14339PMID: 31825745 Originally publishedDecember 11, 2019 PDF download Advertisement