WASHINGTON — Women who had hypertension during pregnancy are at increased risk for hypertension and stroke after 40 years of age.
Follow-up data from more than 4,000 women suggest providers should ask patients about a history of hypertension in pregnancy and note the increased risk of hypertension and stroke in those with such a history, said Dr. Vesna D. Garovic of the department of nephrology and hypertension at the Mayo Clinic in Rochester, Minn.
The current findings support previous research, but earlier studies have been small and registry-based, with limited follow-up, Dr. Garovic said at the annual congress of the International Society for the Study of Hypertension in Pregnancy.
Dr. Garovic and her colleagues reviewed data from 4,782 women in the Family Blood Pressure Program, a multicenter genetic study of high blood pressure and related conditions, to assess the role of hypertension in pregnancy as a risk factor for subsequent stroke and coronary heart disease.
The women were divided into three categories: those with no history of a full-term pregnancy, those with no history of hypertension in pregnancy, and those with a history of hypertension in at least one pregnancy. The women were also asked about other risk factors, including a family history of hypertension and a history of smoking, she explained.
The investigators tracked hypertension and related conditions after the women reached age 40 years. Overall, those with a history of hypertension in pregnancy had a significantly increased risk for hypertension, coronary heart disease (CHD), and stroke, compared with those who were not hypertensive in pregnancy.
After controlling for cardiovascular factors including race, family history of CVD, diabetes, dyslipidemia, and smoking, only the risk for hypertension later in life was significantly higher (hazard ratio, 1.88). After controlling for risk factors for stroke, including subsequent hypertension, the stroke risk was significantly increased (HR 2.10), but the CHDrisk was not.
Women with a history of hypertension in pregnancy also developed hypertension at a younger age than did those who weren't hypertensive in pregnancy. Of 643 women with a history of hypertension in pregnancy, 50% were hypertensive by age 53 years.
“You can postulate that [they] have some underlying increased risk,” but hypertension in pregnancy may cause changes that contribute to an increased risk of future cardiovascular disease, she said, adding tha the study was limited by selection bias and the use of self-reports.
The mechanism of action that connects hypertension in pregnancy to subsequent disease risk remains unknown.
Dr. Garovic stated that she had no conflicts of interest to disclose.