History Of Hypertension In Pregnancy Research Articles

Hypertension in Pregnancy: Current Challenges and Future Opportunities for Surveillance and Research.

Hypertension in pregnancy (HP) includes eclampsia/preeclampsia, chronic hypertension, superimposed preeclampsia, and gestational hypertension. In the United States, HP prevalence doubled over the last three decades, based on birth certificate data. In 2019, the estimated percent of births with a history of HP varied from 10.1% to 15.9% for birth certificate data and hospital discharge records, respectively. The use of electronic medical records may result in identifying an additional third to half of undiagnosed cases of HP. Individuals with gestational hypertension or preeclampsia are at 3.5 times higher risk of progressing to chronic hypertension and from 1.7 to 2.8 times higher risk of developing cardiovascular disease (CVD) after childbirth compared with individuals without these conditions. Interventions to identify and address CVD risk factors among individuals with HP are most effective if started during the first 6 weeks postpartum and implemented during the first year after childbirth. Providing access to affordable health care during the first 12 months after delivery may ensure healthy longevity for individuals with HP. Average attendance rates for postpartum visits in the United States are 72.1%, but the rates vary significantly (from 24.9% to 96.5%). Moreover, even among individuals with CVD risk factors who attend postpartum visits, approximately 40% do not receive counseling on a healthy lifestyle. In the United States, as of the end of September 2023, 38 states and the District of Columbia have extended Medicaid coverage eligibility, eight states plan to implement it, and two states proposed a limited coverage extension from 2 to 12 months after childbirth. Currently, data gaps exist in national health surveillance and health systems to identify and monitor HP. Using multiple data sources, incorporating electronic medical record data algorithms, and standardizing data definitions can improve surveillance, provide opportunities to better track progress, and may help in developing targeted policy recommendations.

Pregnancy Induced Hypertension and It’s Associated Factors among Women Attending Delivery Center

Background: Pregnancy-induced hypertension (PIH) is a dangerous condition that can arise during pregnancy and has been associated with a number of negative outcomes for both the mother and the fetus. According to estimates from the World Health Organization, the effects of hypertensive diseases during pregnancy claim the lives of at least one woman every seven minutes. Examining pregnancy-induced hypertension and associated risk factors in women receiving prenatal treatment at Jalalabad Hospital is the aim of this study. Method: During two months, from October 1 to November 30, 2023, a cross-sectional survey was conducted in the maternity hospitals located in Jalalabad. The hospital provided a proportionate amount of the total sample size (620). Using a systematic sampling procedure, study participants were chosen. A p-value of less than 0.05 was deemed statistically noteworthy. Result: Out of a total of 620 pregnant women, only 8% (50/620) of pregnant women had Hypertensive Disorders in Pregnancy (HDP). The average age of the respondent who visited outpatient department of a maternity hospital in Jalalabad was 27.5± 2 years with the majority 42% in years 25-30. The findings from our study indicate that hypertensive disorder in pregnancy has a significant relationship with risk factors such as increasing maternal age (p<0.041), body mass index (BMI) (P<0.007), and family history of hypertension in pregnancy (p<0.026). Whereas other risk factors assessed in our study had no significant association with HDP. Conclusion: The findings of our study highlight the importance of factors including obesity, advancing pregnancy age, and a family history of hypertension as risk factors for HDP. It also emphasizes the necessity of appropriate preconceptional counseling, regular ANC monitoring, and HDP treatment in order to minimize morbidity and death associated with this condition.

Prevalence of hypertensive disorders of pregnancy, associated factors and pregnancy complications in a primigravida population

BackgroundHypertensive disorders of pregnancy (HDP) are among obstetrics' most intriguing and yet unsolved problems. It is one of the major causes of maternal and perinatal morbidity and mortality. This study estimates the prevalence of hypertensive disorders of pregnancy, their associated risk factors and pregnancy complications in primiparous women. MethodsAll primigravida who gave birth in our hospital from December 2020 to December 2021 were included in the study. The prevalence, risk factors, mode of delivery, and maternal and fetal outcomes of hypertensive disorders of pregnancy in primigravidae were collected from the patient's medical records. Statistical analysis was done using the SPSS 18.0 software package. The Chi-square test was used to analyse the association between the risk factors and hypertensive disorders of pregnancy in primigravida. ResultsA total of 807 women were included in the study, and the mean age was 26.34 ​± ​3.84 years. The prevalence of hypertensive disorders of pregnancy in primigravidae was found to be 18.6%. Among the prevalent population, 79.3% of women had gestational hypertension. The findings indicate that hypertension in pregnancy has a significant relationship with risk factors such as increased maternal age (p ​< ​0.004), family history of hypertension in pregnancy (p ​< ​0.001), body mass index >30 ​kg/m2(p ​< ​0.001), hyperglycaemia in pregnancy (p ​< ​0.001), IVF pregnancy (p ​< ​0.004) and polycystic ovary syndrome (p ​< ​0.001). The most reported adverse maternal and perinatal outcomes were placental abruption (p ​< ​0.001), postpartum haemorrhage (p ​< ​0.001), prematurity (p ​< ​0.001), and fetal growth restriction (p ​< ​0.001). ConclusionThe study emphasises the importance of knowledge and timely assessment of risk factors of HDP. It also highlights the need for pre-conceptional counselling, which includes early detection, careful monitoring and treatment of HDP for preventing morbidity and mortality related to this disorder and it should be followed up even in the postpartum period.

Hypertensive Diseases in Pregnancy and Kidney Function Later in Life: The Genetic Epidemiology Network of Arteriopathy (GENOA) Study

ObjectiveTo evaluate the relationship between hypertensive diseases in pregnancy and kidney function later in life. MethodsWe evaluated measured glomerular filtration rate (mGFR) using iothalamate urinary clearance in 725 women of the Genetic Epidemiology Network of Arteriopathy (GENOA) study. Women were classified by self-report as nulliparous (n=62), a history of normotensive pregnancies (n=544), a history of hypertensive pregnancies (n=102), or a history of pre-eclampsia (n=17). We compared adjusted associations among these four groups with mGFR using generalized estimating equations to account for familial clustering. Chronic kidney disease (CKD) was defined as mGFR of less than 60 mL/min per 1.73 m2 or urinary albumin-creatinine ratio (UACR) greater than or equal to 30 mg/g. ResultsAmong women with kidney function measurements (mean age, 59±9 years, 52.9% African American), those with a history of hypertensive pregnancy had lower mGFR (–4.66 ml/min per 1.73 m2; 95% CI, -9.12 to -0.20) compared with women with a history of normotensive pregnancies. Compared with women with a history of normotensive pregnancies, women with a history of hypertensive pregnancy also had higher odds of mGFR less than 60 ml/min per 1.73 m2 (odds ratio, 2.09; 95% CI, 1.21 to 3.60). Additionally, women with a history of hypertensive pregnancy had greater odds for chronic kidney disease (odds ratio, 4.89; 95% CI, 1.55 to 15.44), after adjusting for age, race, education, smoking history, hypertension, body mass index, and diabetes. ConclusionA history of hypertension in pregnancy is an important prognostic risk factor for kidney disease. To our knowledge, this is the first and largest investigation showing the association between hypertensive diseases in pregnancy and subsequent kidney disease using mGFR in a large biracial cohort.

May Measurement Month 2019: an analysis of blood pressure screening results in the Philippines.

The Philippine Society of Hypertension (PSH) took part again in the annual May Measurement Month 2019 (MMM19) blood pressure (BP) measurement campaign to raise awareness of hypertension especially in those who are not aware of their condition. The MMM19 standard protocol designed by the International Society of Hypertension was used during screening. These included the collection of basic data on demography, lifestyle, and environmental factors. Standardized sitting BP measurements were taken two to three times, using an automated BP apparatus and were inputted either in the MMM19 app or data were recorded in paper form and manually transferred to Excel spreadsheets by encoders supervised by the PSH. A total of 89 941 participated through opportunistic convenience sampling. After multiple imputation, a total of 47 925 (53.3%) participants had hypertension (≥140/90 mmHg or on antihypertensive medication). Of this number, 31 151 (65%) were aware that they had high BP and 30 120 (62.8%) were on antihypertensive medications. Of the 30 120 participants on antihypertensive medications, only 18 373 (61.1%) had controlled BP (<140/90 mmHg). Being overweight or obese were significant predictors of high BP. Other predictors of high systolic BP and diastolic BP were alcohol intake, smoking, and a previous history of hypertension in pregnancy, while pregnant participants had significantly lower BP. The MMM19 campaign succeeded in raising awareness of high BP in our country, and the opportunistic sampling enhanced a sense of people empowerment by their knowing how easy it is to detect high BP and thereby enabling the prevention of long-term health complications. The higher BP control in the MMM19 hypertensive individuals possibly attests to the success of the previous MMM17 and MMM18 campaigns.

May Measurement Month 2019: an analysis of blood pressure screening results from Nigeria.

The aim of this study is to estimate the frequency of undetected hypertension across the six geopolitical zones of Nigeria. We conducted an opportunistic screening of adults aged at least 18 years in the month of May 2019. Participants were recruited by trained volunteers using the May Measurement Month protocol. Blood pressure (BP) was measured using validated digital and mercury sphygmomanometers. We defined hypertension as BP ≥140/90 mmHg or the use of BP-lowering medication. A total of 3646 participants (52.8% females) with a mean age of 44.5 ± 15.7 years were screened. Hypertension was present in 39.2% of the participants but only 55. 4% of these were on antihypertensive medications. Only 46.8% hypertensives who were on medications had their BP controlled (<140/90 mmHg). Previous history of hypertension in pregnancy, alcohol intake and smoking were associated with increased mean systolic and diastolic BPs. The frequency of Nigerians with hypertension is high while only about half of those on antihypertensive medications are controlled. A multi-pronged approach to reduce the burden of hypertension is needed.

Hypertensive diseases in pregnancy, cardiac structure and function later in life: Insights from the Genetic Epidemiology Network of Arteriopathy (GENOA) study.

Hypertensive diseases in pregnancy have been associated with altered cardiac structure and function, yet these associations have not been systematically investigated in larger populations including African Americans. We evaluated the relationships between hypertensive diseases in pregnancy with cardiac structure and function later in life in the Genetic Epidemiology Network of Arteriopathy (GENOA) study. We investigated 1013 African American women sibships with echocardiographic measurements from the GENOA study (Phase II, 2000-05; Jackson, MS). Women were classified as self-reported nulliparous (n=61), a history of normotensive pregnancies (n=780), a history of a hypertensive pregnancies (n=152), or a history of preeclampsia (n=20). We compared adjusted associations among these 4 groups with echocardiographic measurements of cardiac structure and function using generalized estimating equations, accounting for familial clustering. Among 1013 women with echocardiographic data (mean age 62±9.5years), women with a history of hypertensive pregnancy had lower left ventricular ejection fraction (LVEF) (P=0.043) compared to nulliparous women and higher left atrial systolic dimension (LASD) compared to women with a history of normotensive pregnancies (P=0.010), After adjusting for cardiovascular risk factors. There were no statistically significant differences in other echocardiographic parameters among these groups. A history of hypertension in pregnancy is associated with lower LVEF later in life, compared to nulliparous women and higher LASD compared to women with a history of normotensive pregnancies. However, given the multiple comparisons considered, this finding should be interpreted cautiously and requires further study.

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

Hypertensive pregnancy is associated with increased maternal cardiovascular risk in later life. A range of cardiovascular adaptations after pregnancy have been reported to partly explain this risk. We used multimodality imaging to identify whether, by midlife, any pregnancy-associated phenotypes were still identifiable and to what extent they could be explained by blood pressure. Participants were identified by review of hospital maternity records 5 to 10 years after pregnancy and invited to a single visit for detailed cardiovascular imaging phenotyping. One hundred seventy-three women (age, 42±5 years, 70 after normotensive and 103 after hypertensive pregnancy) underwent magnetic resonance imaging of the heart and aorta, echocardiography, and vascular assessment, including capillaroscopy. Women with a history of hypertensive pregnancy had a distinct cardiac geometry with higher left ventricular mass index (49.9±7.1 versus 46.0±6.5 g/m2; P=0.001) and ejection fraction (65.6±5.4% versus 63.7±4.3%; P=0.03) but lower global longitudinal strain (-18.31±4.46% versus -19.94±3.59%; P=0.02). Left atrial volume index was also increased (40.4±9.2 versus 37.3±7.3 mL/m2; P=0.03) and E:A reduced (1.34±0.35 versus 1.52±0.45; P=0.003). Aortic compliance (0.240±0.053 versus 0.258±0.063; P=0.046) and functional capillary density (105.4±23.0 versus 115.2±20.9 capillaries/mm2; P=0.01) were reduced. Only differences in functional capillary density, left ventricular mass, and atrial volume indices remained after adjustment for blood pressure (P<0.01, P=0.01, and P=0.04, respectively). Differences in cardiac structure and geometry, as well as microvascular rarefaction, are evident in midlife after a hypertensive pregnancy, independent of blood pressure. To what extent these phenotypic patterns contribute to cardiovascular disease progression or provide additional measures to improve risk stratification requires further study.

Hypertension in pregnancy: A future risk for chronic kidney disease in South Africa.

Hypertension in pregnancy is a risk factor for end-stage chronic kidney disease (ESKD) and is particularly common in South Africa (SA). There are no data for the risk of developing chronic kidney disease (CKD). To conduct a study of all female patients who presented to the renal replacement programme at Groote Schuur Hospital, Cape Town, SA. This was a retrospective study of female patients with ESKD who were presented to renal replacement meetings between 2007 and 2017. For each patient who was assessed, there was a comprehensive letter detailing patient demographics, as well as psychosocial and medical history, which served as the source data. Patients with a history of hypertension in pregnancy were identified as the case group and those without the condition were the control group. Patient demographics, causes of CKD, kidney function and outcome of the meeting were documented. Of the 415 female patients with ESKD, 70 (16.9%) had a history of hypertension in pregnancy. The ethnic breakdown was as follows: 132 (42.44%) black, 172 (55.3%) mixed ancestry and 7 (2.25%) white. Compared with the control group, the patients were younger, with a median age of 33 v. 41 years (p&lt;0.001), higher serum creatinine 1 045 v. 751 μmol/L (p=0.017) and lower estimated glomerular filtration rate (eGFR) 4.0 v. 5.1 mL/min (p=0.029). Patients were more likely to abuse methamphetamine (5.7 v. 1.7%; p=0.049), and less likely to be diabetic (1.4 v. 20.9%; p&lt;0.001) or HIV-positive (2.9 v. 12.5%; p=0.019). There were no ethnic differences between patients and controls. Underlying causes of renal disease showed significant differences, as patients were more likely to have hypertensive nephropathy (57.1 v. 22.9%; p&lt;0.0001), and less likely to have diabetic kidney disease (1.4 v. 20.4%; p&lt;0.001), HIV-associated nephropathy (HIVAN) (1.4 v. 6.4%) or polycystic kidney disease (1.4 v. 7.0%). There was no difference in acceptance to the dialysis and transplant programme (53 v. 47%). This study suggests an important link between hypertension in pregnancy and ESKD. The patients were significantly younger, presented later and were more likely to have hypertensive nephropathy. Methamphetamine abuse appears to be a risk factor. The study suggests that all women with hypertensive disorders during pregnancy need further evaluation and follow-up postpartum.

Prevalensi Kejadian Preeklampsia dengan Komplikasi dan Faktor Risiko yang Mempengaruhinya di RSUP Dr. Mohammad Hoesin Palembang (Studi Prevalensi Tahun 2015, 2016, 2017)

Preeklampsia dengan komplikasi merupakan penyakit obstetri dengan prevalensi tertinggi di Indonesia sehingga dapat meningkatkan angka mortalitas dan morbiditas ibu dan bayi. Penyakit ini dikenal sebagai the disease of theorydikarenakan belum terdapatnya teori yang mampu menjelaskan faktor risiko penyakit ini secara jelas. Penelitian ini dilakukan untuk mengetahui prevalensi kejadian preeklampsia dengan komplikasi di RSUP Dr. Mohammad Hoesin periode 1 Januari 2015 - 31 Desember 2017 sekaligus menganalisis faktor risiko yang mempengaruhinya. Penelitian ini merupakan penelitian observasional analitik dengan desain cross sectional.Penelitian ini menggunakan data sekunder rekam medik ibu bersalin di RSUP Dr. Mohammad Hoesin Palembang. Sampel penelitian terdiri dari 117 ibu bersalin dengan PDK dan 183 ibu bersalin non-PDK. Data dianalisis menggunakan uji chi-squaredan regresi logistik biner metode Enter pada aplikasi SPSS. Prevalensi kejadian preeklampsia dengan komplikasi di RSUP Dr. Mohammad Hoesin Palembang periode 1 Januari 2015–31 Desember 2017 adalah 14,45%. Hasil analisis bivariat menunjukan usia maternal (p=0,000; PR=2,229; CI 95%: 2,556–7,212), IMT (p=0,000; PR=2,167; CI 95%: 1,525-3,080), riwayat hipertensi dalam kehamilan (p=0,000; PR=3,597; CI 95%: 2.860–4.523), dan jumlah paritas (p=0,007; PR=0,618; risk=1,618; CI 95%: 0.43– 0.883) memiliki hubungan yang signifikan terhadap kejadian preeklampsia dengan komplikasi. Pekerjaan (p=0,065), jarak kehamilan (p=0,458), dan riwayat penyakit maternal (p=0,573) memiliki hubungan yang tidak signifikan terhadap kejadian tersebut. Hasil analisis multivariat menunjukkan usia maternal, pekerjaan, IMT, jarak kehamilan, dan riwayat hipertensi dalam kehamilan memiliki probabilitas sebesar 74,5% terhadap kejadian preeklampsia dengan komplikasi. Prevalensi kejadian preeklampsia dengan komplikasi di RSUP Dr. Mohammad Hoesin masih relatif tinggi, dan faktor risiko yang paling signifikan terhadap kejadian tersebut adalah riwayat hipertensi dalam kehamilan.

Spontaneous Dissection of the Coronary Vessels. Epidemiological and Coronary Angiographic Study.

Introduction:Spontaneous dissection of the coronary arteries is relatively rare and usually does not affect life expectancy. However specific types have been implicated to episodes of sudden cardiac death and myocardial ischemia. The recognition of both clinical and imaging characteristics contributes to appropriate decision and patient management.Aim:The aim of the study is the epidemiological and Coronary Angiographic (CA) estimation of patients with spontaneous dissection of the coronary arteries, who were hospitalized in the cardiology department with Acute Coronary Syndrome or were submitted to coronary angiographic examination in the laboratory.Material and Methods:The epidemiological, clinical and angiographic data of 31 patients who were hospitalized in our department and suffered from spontaneous dissection of the coronary vessels were studied retrospectively.Results:In 31 patients (11 men and 20 women, mean age 52.8+18.6 years) who were hospitalized for acute coronary syndrome (ACS), spontaneous dissection of coronary arteries was detected. Precipitating factors were hypertension in 12 patients (38.71%), dyslipidemia in 13 patients (42%) and smoking in 17 patients (54.84%). Among the women, 13 (65%) had a history of hypertension in pregnancy, preeclampsia or/and gestational diabetes. In 8 patients, the coronary angiography showed multivessel disease, while in 12 patients there were no significant lesions in the coronary vessels. Fourteen women (70%) reported a history of depression compared to none in men.Conclusion:The incidence of spontaneous dissection of the coronary vessels in this sample of patients from northern Greece is similar to that of the other centers. The incidence is greater in females with hormonal changes and depression. In a large number there were no significant atherosclerotic lesions.

393. InterPregGen: The discovery and validation of genetic variants associated with pre-eclampsia in mothers and babies

30 years of molecular genetic studies of common disorders have demonstrated the need for large, well-powered studies to detect genetic variants with individually small effects on disease susceptibility; pre-eclampsia is no exception. InterPregGen is a collaboration between research groups from Europe and Central Asia seeking to identify DNA sequence variants predisposing to pre-eclampsia. The primary approach is meta-analysis of genome-wide association screening (GWAS) data from over 9000 affected mothers, 6500 offspring, and 370,000 control subjects. Variants with evidence of association with pre-eclampsia are followed-up by targeted genotyping in independent sample collections. In offspring affected by pre-eclampsia there is a highly significant association with a common variant located close to the FLT1 gene, which encodes Fms-like tyrosine kinase 1 and its soluble isoform sFlt-1 (P = 5.38 × 10 - 11 ) . The strongest association was in pregnancies with onset of pre-eclampsia after 34 weeks gestation. Investigation of the maternal genome in pre-eclampsia has highlighted associations with multiple DNA variants which also have confirmed associations with essential hypertension in non-pregnant individuals. In a further 2800 women with non-proteinuric gestational hypertension there is a similar profile of susceptibility variants shared with essential hypertension and pre-eclampsia. Typical of many common complex disorders, there is no single ‘pre-eclampsia gene’. Current parental or fetal genotype data do not enable prediction of preeclampsia in individual pregnancies. However, the results highlight specific biological pathways responsible for pre-eclampsia’s aetiology. Larger studies are essential to identify additional variants and other pathways affecting pre-eclampsia. The genetic findings justify targeted investigation of FLT1 regulation in the placenta, and indicate that raised sFlt-1 has a causal role in pre-eclampsia, and is not just a consequence of the disease. Maternal genotyping results confirm a pathophysiological overlap between essential hypertension, gestational hypertension and pre-eclampsia, and emphasise the imperative for long-term cardiovascular monitoring of women with a history of hypertension in pregnancy.

Impact of a History of Hypertension in Pregnancy on Later Diagnosis of Atrial Fibrillation.

BackgroundAtrial fibrillation/flutter (AF) produces significant morbidity in women and is typically attributed to cardiac remodeling from multiple causes, particularly hypertension. Hypertensive pregnancy disorders (HPDs) are associated with future hypertension and adverse cardiac remodeling. We evaluated whether women with AF were more likely to have experienced a HPD compared with those without.Methods and ResultsA nested case–control study was conducted within a cohort of 7566 women who had a live or stillbirth delivery in Olmsted County, Minnesota between 1976 and 1982. AF cases were matched (1:1) to controls based on date of birth, age at first pregnancy, and parity. AF and pregnancy history were confirmed by chart review. We identified 105 AF cases: mean age 57±8 (mean±SD) years, (controls 56±8 years), 32±8 years (controls 31±8 years) after the first pregnancy. Cases were more likely to have obesity during childbearing years, and hypertension, diabetes mellitus, dyslipidemia, coronary disease, valvular disease, and heart failure at the time of AF diagnosis. Cases were more likely to have a history of HPDs, compared with controls: 28/105 (26.7%) cases versus 12/105 (11.4%) controls, odds ratio: 2.60 (95% confidence interval, 1.21–6.04). After adjustment for hypertension and obesity, the association was attenuated and no longer statistically significant; odds ratio (95% confidence interval, 2.12 (0.92–5.23).ConclusionsWomen with AF are more likely to have had a HPD, a relationship at least partially mediated by associated obesity and hypertension. Given the high morbidity of AF, studies evaluating the benefit of screening for and management of cardiovascular risk factors in women with a history of HPD should be performed.

Aortic Hemodynamics and Cognition in Women with a History of Hypertensive Pregnancy

A history of hypertensive disorders of pregnancy, including preeclampsia, place women at an elevated risk of developing hypertension and cognitive impairments as they age. The purpose of this study was to determine if aortic hemodynamics were related to cognition in postmenopausal women with a history of hypertensive disorders of pregnancy. We evaluated 33 postmenopausal women with a history of preeclampsia (PE: age = 59 ± 5 y; BMI = 29 ± 5 kg/m2; years since last pregnancy = 35 ± 3 y) and 29 postmenopausal women with a history of normotensive pregnancy (NTP: age = 59 ± 5 y; BMI = 26 ± 5 kg/m2; years since last pregnancy = 35 ± 3 y). Participants underwent a cognitive testing battery including letter‐number sequencing, trail making test B, letter fluency, and category fluency tests to evaluate executive functioning and working memory. Mean arterial pressure (MAP) was measured with a brachial blood pressure cuff. Applanation tonometry (SphygmoCor) was used to derive the aortic pressure waveform and calculate aortic systolic blood pressure (ASBP), aortic diastolic blood pressure (ADBP), augmentation index (AI), and augmented pressure (AP). There were no differences in cognitive scores between groups (p &gt; 0.05). Brachial blood pressure (MAP: 103 ± 2 vs. 103 ± 3 mmHg) and aortic hemodynamic measures (ASBP: 123 ± 3 vs. 121 ± 3 mmHg; ADBP: 78 ± 2 vs. 77 ± 2 mmHg; AI: 31 ± 2 vs. 28 ± 1 %; AP: 17 ± 1 vs. 15 ± 1 mmHg) were also similar between PE women and NTP women, respectively (p &gt; 0.05 for all). There were no associations between measures of aortic hemodynamics and cognitive scores in women independent of their pregnancy history (p &gt; 0.05). When evaluating these relationships within each group, ADBP was significantly associated with worse scores for letter‐number sequencing and letter fluency in PE women (r = −0.433 and r = −0.441, respectively, p &lt; 0.05). Taken together, our results indicate aortic hemodynamic measures are not associated with cognition in middle‐aged postmenopausal women with different pregnancy histories; however, future studies should address the influence of elevated aortic hemodynamic variables and the longitudinal change in cognitive function in postmenopausal women with different pregnancy histories.Support or Funding InformationNIH AG44170, NIH 118154

Sympathetic responsiveness is not increased in women with a history of hypertensive pregnancy.

Hypertensive pregnancy (HTNP) is a risk factor for future cardiovascular disease. Exaggerated cardiovascular responses to physical stress are also considered an independent marker of cardiovascular disease risk. However, there are limited data regarding the blood pressure (BP) responses to acute stress in women, who have a history of HTNP. Hence, the aim of the study is to compare BP responses to a physical stress in postmenopausal women with a history of HTNP to age- and parity-matched women with a history of normotensive pregnancy (NP). Beat-to-beat BP and heart rate was recorded in 64 postmenopausal women with [age = 58.5 (55.2, 62.2) yr, where values are the median, 25th percentile, and 75th percentile] and without [age = 59.4 (55.9, 62.4) yr] a history of HTNP before and during isometric handgrip (IHG) exercise (30% of maximal voluntary contraction) to fatigue. Muscle metaboreflex was measured during postexercise ischemia following IHG exercise. BP variables increased similarly in response to IHG exercise [systolic: NP = 11.5 (8.9, 17.6) %, HTNP = 11.3 (9.5, 15.9) %; diastolic NP = 11.2 (7.9, 13.3) %, HTNP = 9.5 (7.1, 14.3) %; mean blood pressure: NP = 9.8 (5.0, 13.6) %, and HTNP = 7.2 (4.4, 10.4) %] and postexercise ischemia [systolic: NP = 14.1 (10.3, 23.0) %, HTNP = 15.8 (10.6, 21.4) %; diastolic NP = 12.2 (4.8, 17.0) %, HTNP = 10.4 (5.3, 17.1) %; and mean blood pressure: NP = 11.1 (6.1, 17.9) %, HTNP = 9.4 (2.9, 14.8) %] in both groups. Although having a history of HTNP is associated with future cardiovascular disease risk, results from this study suggest that the risk may not be manifested through altered cardiovascular metaboreflex response to physical stressors.

Sympathetic neural and cardiovascular responses during static handgrip exercise in women with a history of hypertensive pregnancy.

Women with a history of hypertensive pregnancy are at greater risk for future cardiovascular events; however, the mechanisms for this increased risk are unknown. Evidence suggests that an exercise stimulus unmasks latent hypertensive tendencies, identifying individuals at the greatest risk for developing cardiovascular disease. The current study examined the hypothesis that women with a hypertensive pregnancy history exhibit an augmented exercise pressor response. Normotensive women with a history of healthy pregnancy (CON; n=9) and hypertensive pregnancy (HP+; n=12) were studied during the mid-luteal phase of the menstrual cycle. Heart rate (HR), systolic and diastolic blood pressure (SBP, DBP), and muscle sympathetic nerve activity (MSNA) were measured during a cold pressor test (CPT), and, following a sufficient period of recovery, during static handgrip to fatigue (SHG) and post-exercise circulatory arrest (PECA). The BP, HR, and MSNA responses to the CPT were similar between groups. The SBP response to SHG and PECA was similar between groups, but DBP and HR were significantly greater in HP+ women (both p<0.05). MSNA burst frequency, but not burst incidence or total activity, tended to be elevated in HP+ women during the stressor (peak Δ from baseline 31±13 vs. 23±13 bursts/min; p for group=0.06). Despite no clinical signs of cardiovascular disease or hypertension, women with a history of hypertensive pregnancy display an enhanced cardiovascular reactivity to an exercise stimulus compared to women with a healthy pregnancy history. This response may be indicative of impaired cardiovascular control that precedes the clinical manifestation of hypertension or cardiovascular events.

Premature cardiovascular disease following a history of hypertensive disorder of pregnancy

BackgroundFollowing an episode of hypertensive disorder of pregnancy (HDP) women have an increased risk of cardiovascular disease over their lifetime. At the time of acute coronary syndrome we compared clinical information between women with and without a history of hypertension in pregnancy to gain further insight into the pathophysiology of cardiovascular disease in this population. MethodsGENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond—PRemature Acute Coronary SYdrome) is a prospective multicenter study, with recruitment between January 2009 and April 2013, including 242 parous women with premature acute coronary syndrome. ResultsThe median age was 50years (IQR 6) and HDP was common; 43 (17.8%) women had prior gestational hypertension, 33 (13.6%) preeclampsia and 166 (68.6%) a prior normotensive pregnancy. Women with a history of HDP commonly had chronic hypertension and diabetes and those presenting with ST-elevation myocardial infarction were more likely to have a history of preeclampsia (aOR 3.12, 95% CI 1.22–8.01) than were women with prior normotensive pregnancies. Neither gestational hypertension (aOR 1.40, 95% CI 0.60–3.26) nor preeclampsia (aOR 0.63, 95% CI 0.23–1.74) was associated with a higher composite risk of three-vessel, left main or proximal left anterior descending coronary disease. ConclusionIn this study of women with premature cardiovascular disease, ST-elevation myocardial infarction was associated with a history of preeclampsia possibly because of persistent endothelial dysfunction. High-risk coronary lesions on angiography did not appear to have an association with preeclampsia or gestational hypertension despite a high burden of traditional risk factors.

Hypertension in Pregnancy and Future Cardiovascular Event Risk in Siblings.

Hypertension in pregnancy is a risk factor for future hypertension and cardiovascular disease. This may reflect an underlying familial predisposition or persistent damage caused by the hypertensive pregnancy. We sought to isolate the effect of hypertension in pregnancy by comparing the risk of hypertension and cardiovascular disease in women who had hypertension in pregnancy and their sisters who did not using the dataset from the Genetic Epidemiology Network of Arteriopathy study, which examined the genetics of hypertension in white, black, and Hispanic siblings. This analysis included all sibships with at least one parous woman and at least one other sibling. After gathering demographic and pregnancy data, BP and serum analytes were measured. Disease-free survival was examined using Kaplan-Meier curves and Cox proportional hazards regression. Compared with their sisters who did not have hypertension in pregnancy, women who had hypertension in pregnancy were more likely to develop new onset hypertension later in life, after adjusting for body mass index and diabetes (hazard ratio 1.75, 95% confidence interval 1.27-2.42). A sibling history of hypertension in pregnancy was also associated with an increased risk of hypertension in brothers and unaffected sisters, whereas an increased risk of cardiovascular events was observed in brothers only. These results suggest familial factors contribute to the increased risk of future hypertension in women who had hypertension in pregnancy. Further studies are needed to clarify the potential role of nonfamilial factors. Furthermore, a sibling history of hypertension in pregnancy may be a novel familial risk factor for future hypertension.

Left ventricular hypertrophy after hypertensive pregnancy disorders

ObjectiveCardiac changes of hypertensive pregnancy include left ventricular hypertrophy (LVH) and diastolic dysfunction. These are thought to regress postpartum. We hypothesised that women with a history of hypertensive pregnancy would...

O122. The role of framing in modifying behavior to reduce cardiovascular risk after preeclampsia, a vignette study

Introduction Observational studies have consistently described that women with a history of hypertension in pregnancy have a markedly increased risk of cardiovascular disease (CVD) later in life. Pregnancy is suggested as a “stress test” that identifies women who are at risk for developing clinical cardiovascular disease in later life. This opens up the opportunity for preventive measures at a relatively young age. Helping women to address their cardiovascular risk by modifying lifestyle has proven difficult. Motivation to change behaviour is crucial for effective interventions. Research on promoting healthy lifestyle has demonstrated that even subtle differences in message framing can affect (intentions to improve) health-related behavior. So, framing risk information could be effective in motivating these women too. Perceived probability of developing a disease appears to be another important factor influencing people’s motivation to modify behavior. Objectives Investigating the impact of framing information as a health score versus a risk score and the impact of high versus low probability of developing CVD on the willingness to modify behavior after preeclampsia. Methods Obstetric nurses (n = 165) were invited to participate in a questionnaire containing two hypothetical scenarios, a case with mild preeclampsia and a case with severe preeclampsia. Scores of their willingness to modify behaviour were analysed on a Likert scale by ANOVA. Results We found no significant effect of framing F(3,287) = 1.932, p 0.166. A significant main effect was found of the severity of the case (F(3,287) = 11.12, p 0.001) and a non-significant interaction between severity and framing on the willingness to modify behavior (F(3,287) = 0.592, p 0.442). Conclusions Framing information in health or risk score and its interaction with probability is not of influence in motivating women to modify their lifestyle to decrease cardiovascular risk after preeclampsia. Framing in health or risk score does not seem to be contributing in clinical practice. Those who are presented with a higher risk are more motivated to change their lifestyle.