Chronic Hypertensive Women Research Articles

What is in common between preeclampsia, HPS70 and medieval headwear? Part II. Serum HSP70 in superimposed preeclampsia: original study

The objective: to investigate serum heat shock protein 70 (HSP70) concentration in pregnant women with chronic hypertension and superimposed preeclampsia. To assess the prospects of using HSP70 as a superimposed preeclampsia predictor.Materials and methods. The original prospective cohort single-center observational study included 105 pregnant women with chronic hypertension and 34 healthy pregnant women as a control group. Serum HSP70 was measured via enzyme-linked immunosorbent assay. The first measurement point of serum HSP70 was at 28 weeks of gestation, the second measurement point was at 36 weeks in case of absence of preeclampsia or at 29-35 weeks in case of preeclampsia. If signs of preeclampsia appeared later than 36 weeks, additional HSP70 measurement was not performed. Statistical analysis was conducted using EZR 1.55 software.Results. In the study group (105 pregnant women with chronic hypertension), after delivery 30 patients had signs of superimposed preeclampsia (superimposed preeclampsia subgroup) and 75 persons had no signs of superimposed preeclampsia (chronic hypertension subgroup). In the control group (34 healthy pregnant women) 3 patients after delivery had preeclampsia signs (preeclampsia subgroup) and another 31 had no signs of preeclampsia (healthy subgroup).Serum HSP70 levels, obtained at the first measurement point (28 weeks) was statistically significantly different between three subgroups: patients with chronic hypertension vs. patients with superimposed preeclampsia (p<0.01), healthy pregnant women vs. chronic hypertension women (p<0.0001), healthy persons vs. superimposed preeclampsia persons (p<0.0001).Serum HSP70 concentrations at the second measurement point (36 weeks, or 29-35 weeks in case of preeclampsia) also had a statistically significant difference for each pair of subgroups (p<0.001). Given the small number of persons in the preeclampsia subgroup (3 women), it was not included in the calculations.No statistically significant difference between serum HSP70 levels in the first and second measurement points was found in healthy pregnant women subgroup. In the subgroup of pregnant women with chronic hypertension without superimposed preeclampsia complications, a statistically significant increased serum HSP70 concentration was found at 36 weeks compared to 28 weeks (p<0.0001). Even bigger growth of HSP70 levels compared to 28 weeks occurred in case of joining preeclampsia to chronic hypertension (p<0.0001).Conclusions. The data suggest an increased concentration of HSP70 in pregnant women with superimposed preeclampsia compared to pregnant women with chronic hypertension of the corresponding term. Thus, it is possible to assume that HSP70 plays a role in superimposed preeclampsia pathogenesis.The increased serum HSP70 levels in pregnant women with chronic hypertension, compared to healthy pregnant women of the corresponding gestational age was determined. Therefore, it can be argued that HSP70 has an influence on the course of chronic hypertension during pregnancy.No statistically significant dependance of serum HSP70 level in healthy pregnant women on gestational age was found. The increase in the level of HSP70 in pregnant women with chronic hypertension with increasing gestational age is most likely due to the progression of hypertensive disorders and/or related conditions. The highest HSP70 increase was observed in pregnant women with chronic hypertension with the addition of preeclampsia.The use of HSP70 as the only predictor of superimposed preeclampsia is not effective, given its non-specificity, but the use of this indicator in combination with other markers is promising and requires further study.

Chronic Hypertension in Pregnancy and Placenta-Mediated Complications Regardless of Preeclampsia.

The prevalence of chronic hypertension in women of reproductive age is on the rise mainly due to delayed childbearing. Maternal chronic hypertension, prevailing prior to conception or manifesting within the early gestational period, poses a substantial risk for the development of preeclampsia with adverse maternal and fetal outcomes, specifically as a result of placental dysfunction. We aimed to investigate whether chronic hypertension is associated with placenta-mediated complications regardless of the development of preeclampsia in pregnancy. This was a population-based, retrospective cohort study from 'Soroka' university medical center (SUMC) in Israel, of women who gave birth between 1991 and 2021, comparing placenta-mediated complications (including fetal growth restriction (FGR), placental abruption, preterm delivery, and perinatal mortality) in women with and without chronic hypertension. Generalized estimating equation (GEE) models were used for each outcome to control for possible confounding factors. A total of 356,356 deliveries met the study's inclusion criteria. Of them, 3949 (1.1%) deliveries were of mothers with chronic hypertension. Women with chronic hypertension had significantly higher rates of all placenta-mediated complications investigated in this study. The GEE models adjusting for preeclampsia and other confounding factors affirmed that chronic hypertension is independently associated with all the studied placental complications except placental abruption. Chronic hypertension in pregnancy is associated with placenta-mediated complications, regardless of preeclampsia. Therefore, early diagnosis of chronic hypertension is warranted in order to provide adequate pregnancy follow-up and close monitoring for placental complications, especially in an era of advanced maternal age.

CASE REPORT OF A RARE CAUSE OF SECONDARY HYPERTENSION ILLUSTRATING THE IMPORTANCE OF CARDIO-OBSTETRICS PRECONCEPTION COUNSELING

Objective: Our objective is to illustrate the value of preconception management of rare case of secondary hypertension namely Middle Aortic Coarctation (MAC), which is characterized by a constriction of the upper abdominal aorta. During pregnancy, MAC can lead to feto-maternal unfavorable hemodynamic balance (Fig.1). On the one hand, elevation of the arterial blood pressure (BP) of the upper part of the body increases the maternal cardiovascular risk i.e. stroke or aortic dissection. On the other hand, hypo-perfusion of the lower part of the body reduces uterine perfusion, increases fetal risk of preeclampsia, placental insufficiency or fetal growth restriction. Design and method: Here, we report the case of a 30-year-old woman with severe hypertension and plans to become pregnant. She previously underwent percutaneous transluminal angioplasty (PTA) and aortic stenting and presented with elevated BP in both arms (right 177/117 mmHg, left 180/121 mmHg) and decreased ABI bilaterally (Tab. 1). A computed tomography angiography of the aorta was performed showing an aortic stent in a supraceliac position with 79% in-stent stenosis. She underwent a new PTA with in-stent re-stenting (Fig. 2). Results: Post PCA, the four extremities BP measurements showed a reduction of her BP values and a normalization of the ABI bilaterally (Table 1). 24h-ABPM confirmed the BP reduction (mean 24h- systolic BP of 135 mmHg, diastolic BP of 101 mmHg), but still remaining-elevated. Therefore, we started an antihypertensive treatment with a successful BP control (125/82 mmHg). Conclusions: The management of MAC in already pregnant women can be particularly challenging. Indeed, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are contraindicated. Furthermore, PTA during pregnancy expose the fetus to radiation and reports for CoA angioplasty and stenting during pregnancy are very limited. Herby, we decided on an interventional rather than conservative approach. This case illustrates the importance of preconception screening and treatment of chronic hypertension in women with plans to become pregnant. It highlights the fact that secondary causes of hypertension do not have to be overlooked in this population.

Characteristics and fetal outcomes of pregnant women with hypertensive disorders in China: a 9-year national hospital-based cohort study

Hypertensive disorders of pregnancy (HDP) are a growing concern and a challenge for maternity care providers as the prevalence of hypertension continues to increase. However, optimal management of HDP is unclear. Therefore, we aimed to explore the differences in adverse fetal outcomes among women with different subtypes of HDP and different blood pressure (BP) levels, to provide evidence-based management of HDP. We obtained data from China's National Maternal Near-Miss Surveillance System from 2012 to 2020. Associations between BP management and adverse fetal outcomes, stratified by the four subtypes of HDP, were assessed using logistic regression analysis with a robust variance estimator. For the period, a total of 393,353 pregnant women with HDP were included in the study; 8.51% had chronic hypertension, 2.27% had superimposed preeclampsia, 50.17% had preeclampsia or eclampsia, and 39.04% had gestational hypertension. The BP levels at delivery admission were mostly (61.14%) of non-severe stage 2 (systolic BP 140-159mm Hg and/or diastolic BP 90-109mm Hg) hypertension by American Heart Association classification. A high rate of adverse fetal outcomes was observed among women with HDP, especially among those aged < 20 or > 35 y or those diagnosed with superimposed preeclampsia. Compared with those with normal BP levels at delivery admission, we found an upward curve with increased risk among pregnant women with more severe BP levels, including the risk of preterm birth and small for gestational age (SGA) fetus. The odds ratios (ORs) of stillbirth, neonatal death, and low Apgar scores associated with severe stage 2 hypertension increased significantly. In addition, the association between BP at admission and fetal outcomes differed among women with varying HDP subtypes. Pregnant women with preeclampsia or eclampsia had an increased risk for preterm birth (adjusted OR [aOR], 1.33 [95% confidence interval {CI}, 1.07 ~ 1.65]) and SGA (aOR, 1.37 [95% CI, 1.10 ~ 1.71]) even when the admission BP was at stage 1 level. Greater attention should be paid to cases involving preeclampsia superimposed on chronic hypertension and pregnant women aged < 20 or > 35 y to mitigate the burden of adverse fetal outcomes caused by HDP.

Cardiovascular Disease-Associated MicroRNA Dysregulation during the First Trimester of Gestation in Women with Chronic Hypertension and Normotensive Women Subsequently Developing Gestational Hypertension or Preeclampsia with or without Fetal Growth Restriction.

The aim of the study was to assess if cardiovascular disease-associated microRNAs would be able to predict during the early stages of gestation (within 10 to 13 weeks) subsequent onset of hypertensive pregnancy-related complications: gestational hypertension (GH) or preeclampsia (PE). Secondly, the goal of the study was to assess if cardiovascular disease-associated microRNAs would be able to detect the presence of chronic hypertension in early pregnancies. The retrospective study was performed on whole peripheral blood samples collected from singleton Caucasian pregnancies within the period November 2012 to March 2020. The case control study, nested in a cohort, involved all women with chronic hypertension (n = 29), all normotensive women that later developed GH (n = 83) or PE with or without fetal growth restriction (FGR) (n = 66), and 80 controls selected on the base of equal sample storage time. Whole peripheral blood profiling was performed with the selection of 29 cardiovascular disease-associated microRNAs using real-time RT-PCR. Upregulation of miR-1-3p (51.72% at 10.0% FPR) was observed in patients with chronic hypertension only. Upregulation of miR-20a-5p (44.83% and 33.33% at 10.0% FPR) and miR-146a-5p (65.52% and 42.42% at 10.0% FPR) was observed in patients with chronic hypertension and normotensive women with later occurrence of PE. Upregulation of miR-181a-5p was detected in normotensive women subsequently developing GH (22.89% at 10.0% FPR) or PE (40.91% at 10.0% FPR). In a part of women with subsequent onset of PE, upregulation of miR-143-3p (24.24% at 10.0% FPR), miR-145-5p (21.21% at 10.0% FPR), and miR-574-3p (27.27% at 10.0% FPR) was also present. The combination of microRNA biomarkers (miR-20a-5p, miR-143-3p, miR-145-5p, miR-146a-5p, miR-181a-5p, and miR-574-3p) can predict the later occurrence of PE in 48.48% of pregnancies at 10.0% FPR in early stages of gestation. The combination of upregulated microRNA biomarkers (miR-1-3p, miR-20a-5p, and miR-146a-5p) is able to identify 72.41% of pregnancies with chronic hypertension at 10.0% FPR in early stages of gestation. Cardiovascular disease-associated microRNAs represent promising biomarkers with very good diagnostical potential to be implemented into the current first trimester screening program to predict later occurrence of PE with or without FGR. The comparison of the predictive results of the routine first trimester screening for PE and/or FGR based on the criteria of the Fetal Medicine Foundation and the first trimester screening for PE wo/w FGR using a panel of six cardiovascular disease-associated microRNAs only revealed that the detection rate of PE increased 1.45-fold (48.48% vs. 33.33%).

35 Additive risk of chronic hypertension in women with pregestational diabetes

Pregestational diabetes (PDM) often co-exists with chronic hypertension (cHTN), and both are associated with substantial risk for several adverse perinatal outcomes including fetal death. We sought to quantify the additive risk of a concurrent diagnosis of chronic hypertension and pregestational diabetes on pregnancy outcomes. This was a population based retrospective cohort study of all singleton births in the United States occurring >20 weeks’ gestation using national live birth and fetal death certificate data from 2018. Patients were grouped by presence of underlying cHTN, PDM, both or none. Baseline demographics and pregnancy outcomes were compared in a univariate analysis. Poisson regression with robust error variance was used to generate adjusted relative risks (aRR) and 95% confidence intervals (CI) for the studied outcome controlling for confounders. There were 3,590,179 women included in the analysis and 0.8% had PDM, 1.9% had cHTN and 0.2% had both. There were increased risks of all studied outcomes in women with PDM or cHTN compared to women without PDM or cHTN, but these risks were greatest when both co-morbidities were present (Table 1). Women with both conditions had significantly increased risks of both early (aRR 5.08, CI 3.95-6.53) and late (aRR 7.10, CI 5.74-8.77) fetal death (Figure 1). Large (LGA) and small for gestational age (SGA) birthweight was more common in women with only PDM and cHTN, respectively. However, women with both had reduced rates of LGA (25.9% vs 30.2%; p<.001) and increased rates of SGA (8.9% vs 6.3%; p<.001) when compared to PDM alone. Women with both PDM and cHTN have substantially increased risks for adverse perinatal outcomes that appear to be additive to having either condition alone. The fetal growth pattern seen in these patients may represent the combined effect of hyperglycemia and placental insufficiency, which could contribute to the increased rates of fetal death in this population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum

The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum

Provoking factors for postpartum chronic hypertension in women with preceding gestational hypertension/preeclampsia: A longitudinal cohort study of 22,798 pregnancies.

Background: A proportion of women with pregnancies complicated by gestational hypertension/preeclampsia (GH-PE) will have persistent postpartum chronic hypertension (CHTN). Common risk factors for postpartum CHTN include older age, pre-existing CHTN, smoking, pre-pregnancy obesity (elevated BMI), and co-morbidities such as thyroid disorders. However, most of explored risk factors are pre-pregnancy factors, and were mainly based on studies with small sample size.Methods: To investigate provoking pre-pregnancy and intra-pregnancy factors for postpartum CHTN in women with preceding GH-PE, the cohort study enrolled 22,798 index pregnancies to analyze individual characteristics, co-morbidities and postpartum outcomes after excluding women with pre-existing CHTN.Results: Among 2,132 GH-PE pregnancies, 428 (20.1%) were complicated with postpartum CHTN. After adjustment, logistic regression analysis revealed excessive pregnant weight gain (≥10 kgw at 28 weeks' gestation) (OR: 14.50, 95% CI: 11.02-19.08) and gestational diabetes mellitus (GDM) (OR: 6.25, 95% CI: 4.98-7.85) were major risk factors for developing CHTN, other than age (OR: 1.80, 95% CI: 1.68-1.93), pre-pregnancy BMI (OR: 3.15, 95% CI: 2.75-3.60), severity of GH-PE (OR: 2.46, 95% CI: 1.97-3.07), smoking (OR: 1.79, 95% CI: 1.35-2.38), and overt DM (OR: 2.30, 95% CI: 1.73-3.06).Conclusion: Excessive pregnant weight gain and GDM are major intra-pregnancy risk factors for postpartum CHTN in women with preceding GH-PE. Future studies should investigate interventions such as a healthy diet, appropriate physical exercise and avoidance of excessive pregnant weight gain as a means to reduce the frequency of CHTN following pregnancy.

The Impact of Multi-Drug Therapy on Pregnancies of Chronic Hypertensive Women [26K

INTRODUCTION: Our group has previously described the high frequency of preterm birth and superimposed preeclampsia in women treated during pregnancy for chronic hypertension (CHTN). We hypothesized that women with CHTN requiring more than one medication for control may be at increased risk for these adverse perinatal outcomes. METHODS: This was a retrospective study of pregnant women with CHTN who delivered from June 2009 to January 2016. These women were treated with a-adrenergic agonists, combined a-B blockers, calcium channel blockers, or a combination thereof. Regimens were adjusted to achieve blood pressures &lt;150 mm Hg systolic and &lt;100 mm Hg diastolic based on recommendations of the ACOG Task Force of Hypertension in Pregnancy. Perinatal outcomes were analyzed by the number of medications needed to achieve the desired blood pressure (BP). RESULTS: There were a total of 419 women with treated CHTN. Fifty (12%) required the use of more than one medication for BP control. There were no differences in maternal baseline characteristics other than duration of diagnosis in those requiring more than one medication (P=.037). Requiring more than one anti-hypertensive medication during pregnancy was associated with a greater risk for superimposed severe preeclampsia (P=.011), delivery &lt;34 weeks (P&lt;.001), and birthweight &lt;2,500 g (P&lt;.001). This burden of preterm birth correlated with an increased frequency of admission to neonatal intensive care (P=.037), development of bronchopulmonary dysplasia (P=.003), surfactant use (P=.02), and phototherapy (P=.015). CONCLUSION: Women who require more than one medication for BP control have increased frequencies of adverse perinatal outcomes specifically linked to indicated, early preterm birth.

Arachidonic acid metabolites of CYP4A and CYP4F are altered in women with preeclampsia

Few studies exist on cytochrome P450 (CYP450) metabolites of arachidonic acid (AA) pertaining to the pathophysiological events in pregnancy. We hypothesized that metabolism of AA via the CYP450 pathways is altered within the placenta in women with preeclampsia (PE) and contributes to the pathophysiology of the disease. Thus, placental vascular CYP450 enzyme expression and activity were measured in normal pregnant (NP) and preeclamptic (PE) patients. CYP450 isoform expression (CYP4A11, CYP4A22, CYP4F2, and CYP4F3) was found to be elevated within the placenta of women with PE compared to normal pregnant (NP) women and chronic hypertensive (CHTN) pregnant women. In addition, placental production of 20-HETE was significantly increased in PE women compared to both NP and CHTN women. Moreover, there was an imbalance in circulating 20-HETE:EETs in PE women. To examine whether alterations in CYP450 AA metabolism contribute to the altered placentation in PE, trophoblast function, proliferation and migration were assessed in the presence of exogenous 20-HETE and a 20-HETE specific synthesis inhibitor, HET0016. Trophoblast proliferation was significantly increased in the presence of 20-HETE (1 μM) and reduced with 20-HETE blockade by HET0016 (1 mM, 5 mM, and 10 mM). On the contrary, administration of exogenous 20-HETE (1 μM) significantly reduced trophoblast migration. In conclusion, metabolism of AA via CYP450 is altered in PE, and increased placental production of 20-HETE may contribute to the pathophysiology of the disease.

Expression and significance of aquaporin-2 and serum hormones in placenta of patients with preeclampsia

To evaluate the relationship between serum hormone or aquaporin-2 (AQP-2) and preeclampsia, patients with severe preeclampsia (A group), mild preeclampsia (B group), chronic hypertension (C group) and normal pregnant women (D group) were recruited and analysed. The AQP-2 level in placenta tissues was detected and the correlations of AQP-2 with serum hormone levels were analysed using linear correlation regression analysis. The differences of alpha foetal protein (AFP) and human chorionic gonadotropin (HCG) levels during mid-pregnancy, as well as the levels of AFP, HCG, unconjugated oestriol and progesterone during late pregnancy were significant among A, B, C and D groups (p < .05). The AQP-2 level in placenta tissues was higher in A group than that in other groups (p < .05). The AQP-2 was correlated with HCG (p < .05). In conclusion, AQP-2 may be involved in the development of severe preeclampsia, which may be related to serum HCG.

P 34 Does performance of mean arterial blood pressure for the screening of preeclampsia improve after controlling for the use of anti-hypertensive medication?

Question Mean arterial pressure (MAP) is a useful biomarker for the screening of preeclampsia (PE). However, MAP, a function of cardiac output and peripheral resistance, is dependent on other maternal characteristics and, for its effective use in screening, these need to be taken into account. One such characteristic is the use of anti-hypertensive medication. The aim of our study was to evaluate the impact of the use of anti-hypertensive medication on the performance of MAP as a screening tool for PE in pregnant women with chronic hypertension or a history of gestational hypertension. Methods A retrospective study was conducted on women with chronic hypertension (N = 478) and normotensive women with a history of gestational hypertension (N = 511) who booked with the Antenatal Hypertension Clinic, Kings College Hospital, London, between 2009–2016. Blood pressure was measured repeatedly antenatally using an automated device validated for use in pregnancy and PE. The more updated International Society for the Study of Hypertension in Pregnancy (ISSHP)-2014 definition of PE was used. We constructed probit Receiver Operating Characteristic Curves (ROC) models to determine the predictive capacity of MAP in women taking anti-hypertensive medication and in those who were not. Wald tests of the null hypothesis that the two ROC curves are equal at different false-positive rates were performed. Age and medication use were taken into account in the comparisons. Results The area under the curves (AUC) for the prediction of PE (p = Conclusion The ability of MAP to predict PE and renal dysfunction is significantly improved by controlling for the use of anti-hypertensive medication in a high-risk pregnant population.

P 33 Does the performance of mean arterial pressure for the screening of preeclampsia differ between women with chronic hypertension and women with a history of gestational hypertension?

Question Recent studies have demonstrated that different parameters of blood pressure may hold valuable information not only in the diagnosis of preeclampsia (PE) but also in identifying women in their first and second trimester at risk of developing PE later in the pregnancy. One such promising component is mean arterial blood pressure (MAP). This study aims to examine the prediction of MAP for PE, renal dysfunction, liver dysfunction and fetal growth restriction (FGR) in two groups of high-risk pregnant women: with chronic hypertension or a history of gestational hypertension. Methods A retrospective study was conducted on women with chronic hypertension ( N = 478) and normotensive women with a history of gestational hypertension ( N = 511) who booked with the Antenatal Hypertension Clinic, Kings College Hospital, London, between 2009–2016. Blood pressure was measured repeatedly antenatally using an automated device validated for use in pregnancy and PE. The updated International Society for the Study of Hypertension in Pregnancy (ISSHP)-2014 definition of PE was used. We constructed probit models to determine the predictive capacity of MAP by comparing the Receiver Operating Characteristic Curves (ROC) in the two groups. Wald tests of the null hypothesis that the two ROC curves are equal at different false-positive rates were performed. Age and medication use were taken into account in the comparisons. STATA 14.0 was used for the analysis. Results The area under the curves (AUC) for the prediction of PE ( p = p = 0.079) was 0.66 (95% CI: 0.62–0.71) and 0.79 (95% CI: 0.74–0.85) for women with chronic hypertension and history of gestational hypertension, respectively (Fig. 1). There were no differences found between the AUC for the prediction of FGR and liver dysfunction. Estimates were adjusted for age and medication use, with the latter being strongly associated with hypertension status. Conclusion The ability of MAP to predict PE and renal dysfunction is significantly affected by the woman’s hypertensive status, with improved performance in women with a history of gestational hypertension.

Chronic Hypertension in Women after Perinatal Exposure to Preeclampsia, Being Born Small for Gestational Age or Preterm.

There is an established association between adverse events during perinatal life and chronic hypertension in adult life. However, disadvantageous conditions often co-exist in the same pregnancy. We investigated single and joint perinatal exposure to preeclampsia, being born small for gestational age (SGA) or preterm and subsequent risk of chronic hypertension. The study population consisted of 731 008 primiparous women from Norway and Sweden registered in the Medical Birth Registers, both as infants and as first time mothers between 1967-2009 (Norway) and 1973-2010 (Sweden). Risk of chronic hypertension in early pregnancy was calculated in women with perinatal exposures to preeclampsia, born SGA or preterm by log-binominal regression analysis, and adjusted for maternal age and level of education in the first generation. The rate of chronic hypertension was 0.4%. Risk of chronic hypertension was associated with single perinatal exposure to preeclampsia, being born SGA or preterm with adjusted relative risk (95% confidence interval, CI) of 2.2 (95% CI 1.8, 2.7), 1.1 (95% CI 1.0, 1.3), and 1.3 (95% CI 1.0, 1.5) respectively. The risks increased after joint exposures, with an almost fourfold risk increase after perinatal exposure to preeclampsia and preterm birth. Additional adjustment for BMI and smoking in the second generation in a subset of the cohort only had a minor impact on the results. Perinatal exposure to preeclampsia, being born SGA or preterm is independently associated with increased risk of chronic hypertension. The highest risk was seen after exposure to preeclampsia, especially if combined with SGA or preterm birth.

E1. Risk of chronic hypertension in women with a history of hypertensive disorders of pregnancy – a nationwide cohort study

Background: Women with a history of hypertensive disorders of pregnancy (HDP) are known to have an increased risk of hypertension years after their pregnancy. However, how soon after an affected pregnancy the risk of hypertension increases and how/whether this risk evolves over time, is unclear.Method: Using national health register data, we identified all women giving birth in Denmark from 1978 to 2011. Cox regression analysis was used to compare the rates of incident post-pregnancy hypertension requiring treatment with medication after pregnancy in women with and without a history of HDP, by the number of years since pregnancy.Findings: In the first 3 years after a woman’s latest pregnancy, rates of chronic hypertension were 4- to 9-fold higher in women with an HDP in that pregnancy than in women with a normotensive pregnancy. The difference in rates between the two groups declined progressively with time, but even after ≥20 years, rates of chronic hypertension were twice as high among women with an HDP in their latest pregnancy. Gestational hypertension was associated with significantly higher rates of later hypertension than preeclampsia, while moderate and severe preeclampsia were associated with similar increases in risk of later hypertension. Women with HDP-affected pregnancies in their 20s, 30s and 40s, respectively had 10-year cumulative incidences of chronic hypertension between 10% and 30%, whereas for women with normotensive pregnancies in their 20s, 30s and 40s, the corresponding cumulative incidences fell between 4% and 12% (for all three age groups, the cumulative incidences for the HDP and non-HDP groups were statistically significantly different).Interpretation: The increased risk of chronic hypertension associated with a previous HDP is already present soon after delivery, and is substantial in all age groups. Women with an HDP affected pregnancy in their 20s had the same post-pregnancy 10-year cumulative risk of chronic hypertension as women with normotensive pregnancies who were 20 years older. These findings suggest that blood pressure monitoring in women with a history of HDP should be initiated soon after the affected pregnancy.

The Risk Factors That Predict Chronic Hypertension After Delivery in Women With a History of Hypertensive Disorders of Pregnancy.

Hypertensive disorders of pregnancy (HDP) is one of the most important lethal complications in pregnant mothers. It is also associated with the subsequent development of chronic hypertension. The objective of this study was to identify the clinical risk factors of postpartum chronic hypertension in women diagnosed with HDP.Six hundred patients as HDP, who diagnosed and followed-up at least 6 month after delivery, were included in the study. We divided the included subjects in 2 groups based on the development of postpartum chronic hypertension: presenting with the chronic hypertension, “case group” (n = 41) and without chronic hypertension, “control group” (n = 559).Clinical and demographic factors were evaluated. By multiple regression analysis, early onset hypertension with end-organ dysfunction, smoking, higher prepregnancy body mass index (BMI), and comorbidities, systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APLS), were associated with progression to chronic hypertension in the postpartum period. The value of area under the curves (AUC) for the 5 models, that generated to combine the significant factors, increased from 0.645 to 0.831, which indicated improved prediction of progression to the chronic hypertension. Additional multivariate analysis revealed significant specific risk factors.This retrospective single hospital-based study demonstrated that the clinical risk factors, that is early onset hypertension with end-organ dysfunction, smoking, and higher prepregnancy BMI, were significant independent predictors of chronic hypertension in women after delivery. Identification of risk factors allowed us to narrow the subject field for monitoring and managing high blood pressure in the postpartum period.

Factors That Predict the Development of Hypertension in Women With Pregnancy-Induced Hypertension

Pregnancy-induced hypertension (PIH) is associated with chronic hypertension (HTN) and cardiovascular complications. We investigated the factors that predict the development of chronic HTN in women with PIH. The study population comprised 108 women with PIH and 87 healthy age-matched women control subjects who gave birth during the years 1990-1994 at the Chaim Sheba Medical Center, Israel, and were followed for up to 23 years (average 20.8 ± 1.4). We analyzed the association between PIH and subsequent HTN and cardiovascular complications, aiming to identify predicting factors for the development of chronic HTN in this subject population. At the time of index pregnancy, women with PIH were more likely to be overweight, had elevated blood pressure (BP) levels, a shorter gestational period, required more cesarean sections, and were more likely to deliver small infants than the control group. Compared to women with normotensive pregnancy, women with PIH had 11-fold higher age-adjusted risk of developing HTN. They also had a higher body mass index (BMI), and were more likely to develop diabetes mellitus (DM) and coronary artery disease, during follow-up. Among women with PIH, those subjects who developed HTN were older during pregnancy, had higher BMI and more deliveries before the index pregnancy. Our findings confirm the association between PIH and chronic HTN. In women with PIH, high BMI and more previous pregnancies are risk factors for developing HTN. Thus, obese women with multiple pregnancies who develop PIH should be more closely followed for the development of HTN.

Factors that predict the development of hypertension in women with pregnancy induced hypertension

Background Pregnancy-induced hypertension (PIH) is associated with chronic hypertension (HTN) and cardiovascular complications. We investigated the factors that predict the development of chronic HTN in women with PIH. Methods The study population comprised 108 women with PIH and 87 healthy age-matched women control subjects who gave birth during the years 1990-1994 at the Chaim Sheba Medical Center, Israel, and were followed for up to 23 years (average 20.8 ± 1.4). We analyzed the association between PIH and subsequent HTN and cardiovascular complications, aiming to identify predicting factors for the development of chronic HTN in this subject population. Results At the time of index pregnancy, women with PIH were more likely to be overweight, had elevated blood pressure (BP) levels, a shorter gestational period, required more cesarean sections, and were more likely to deliver small infants than the control group. Compared to women with normotensive pregnancy, women with PIH had 11-fold higher age-adjusted risk of developing HTN. They also had a higher body mass index (BMI), and were more likely to develop diabetes mellitus (DM) and coronary artery disease, during follow-up. Among women with PIH, those subjects who developed HTN were older during pregnancy, had higher BMI and more deliveries before the index pregnancy. Conclusion Our findings confirm the association between PIH and chronic HTN. In women with PIH, high BMI and more previous pregnancies are risk factors for developing HTN. Thus, obese women with multiple pregnancies who develop PIH should be more closely followed for the development of HTN.

144-POS

Objectives Compare the maternal and perinatal outcomes of vaginal parturition among pregnant women with chronic arterial hypertension (CAH) and normotensive pregnant women. Methods A transversal, retrospective and comparative study was performed involving 31 pregnant women with CAH that were accepted on the Hospital Guilherme Alvaro’s Prenatal Service for Expecting Women with Hypertension or Nephropathies in Santos-SP/Brazil (January 2012–December 2013) and that had obstetric resolution by vaginal delivery. For the control group were selected pregnant women without hypertension or any other comorbidities who have had obstetric resolution by vaginal delivery subsequently to the pathological pregnant women. To compare the groups the Student’s t test and Fisher’s exact test were used. Results The groups differ with regard to the following variables: age (hypertensives, in average, 7.6 years older; p p p p p p > 0.05) when compared the variables APGAR on 1′ and 5′, maternal complications, perinatal complications, birth weight and need for Neonatal Intensive Care Unit hospitalization. Conclusions In order to reduce the high rate of cesarean sections in chronic hypertensive women, strategies could be adopted to encourage vaginal delivery in these pregnant women, considering that on the study, maternal and perinatal outcomes were favorable. Despite the small sample in this study, there were no adverse maternal and perinatal outcomes that contraindicate vaginal delivery in patients with chronic arterial hypertension. Disclosures M. David: None. P. Rahe: None. V. de Campos: None. M. da Silva: None. F. Marques: None. K. Dom Bosco: None. J. Del Sant: None. J. Garcia: None. M. Paltronieri: None. M. Saito: None. S. de Toledo: None. R. Guidoni: None. N. Sass: None. F. Sousa: None.

Uterine artery impedance during puerperium in normotensive and chronic hypertensive pregnant women.

The present study compared the Doppler flow pulsatility indices (PI) in the uterine arteries (UtA) during the puerperium between healthy women and those with stage-1 essential hypertension who had uncomplicated pregnancies and delivered by elective caesarean section. The change in the mean arterial pressure (MAP) and body mass index (BMI) over time was also assessed. A longitudinal and prospective study was performed in singleton pregnancies of 28 normotensive (NT) and 24 hypertensive (HT) women. The UtA-PI was measured immediately before caesarean section (time 0) and at 1 week (time 1) and 4 weeks (time 2) postpartum. The presence or absence of early diastolic notches was recorded. The change in the MAP, BMI, and UtA-PI over time and between the two populations was modelled through multivariate linear regression using the generalised least squares. In both groups, the UtA-PI significantly increased from time 0 to time 1 (p < 0.05) and time 2 (p < 0.05). Stage-1 hypertension did not change the trend but did increase the UtA-PI magnitude (p < 0.05). The presence of uterine artery notching increased over time, from 6 to 98%, in both groups (p < 0.001); however, in the HT group, at time 1, the majority of women exhibited positive notching [92% (HT) vs 57% (NT), p = 0.013]. Chronic stage-1 hypertensive women with normal pregnancy outcomes exhibited a progressively increasing postpartum UtA impedance. This trend also occurred in normotensive women, albeit at a significantly lower magnitude.