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Cardiovascular and metabolic characteristics 40 years after hypertensive pregnancies: a long-term follow-up study of mothers

Collén, Anna-Claraa; Hellgren, Margaretab; Gustafsson, Helenac; Johansson, Magnus C.d; Manhem, Karina

doi: 10.1097/HJH.0b013e32835e2a9b
ORIGINAL PAPERS: Pregnancy hypertension

Objectives: Maternal cardiovascular morbidity is increased after hypertensive pregnancies (HTP). The pathways from complicated pregnancies to future cardiovascular disease are complex. The aim of the present study was to test the hypothesis that different cardiovascular mechanisms are changed in women who experienced HTP four decades earlier in comparison to women with normotensive pregnancies.

Methods: One hundred and five women (50 with hypertensive and 55 with normal pregnancies) were examined with anthropometric measurements; office blood pressure, ambulatory blood pressure and central blood pressure, pulse wave velocity, augmentation index, intimal–media thickness, echocardiography and laboratory measurements. In addition another 204 women were followed-up by a questionnaire regarding their pregnancy 40 years ago, as well as their present health status and medications.

Results: Women with HTP had more often diagnosed hypertension when compared with women with normal pregnancies (50 vs. 31%, respectively; P = 0.046), but the groups did not differ in any blood pressure levels. HTP were associated with higher pulse wave velocity (8.8 m/s vs. 7.8 m/s, P = 0.021), and higher levels of P-glucose (5.7 mmol/l vs. 5.2 mmol/l, P = 0.022), P-HbA1c (4.4% vs. 4.2%, P = 0.010) and noradrenaline (2.45 mmol/l vs. 2.11 mmol/l, P = 0.040) when compared with normotensive pregnancies. Women followed up with a questionnaire reported deteriorated cardiovascular health compared to women attending the clinical investigations of the study.

Conclusion: HTP are associated with impairment in vascular function and metabolic status 40 years postpartum despite well controlled blood pressure levels.

aInstitute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital, Sahlgrenska Academy, Göteborg University

bDepartment of Obstetrics, Sahlgrenska University Hospital, Gothenburg and Department of Prenatal Care, Primary Care, South Bohuslän

cDepartment of Physiology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy and University of Gothenburg and Department of Medicine, Sahlgrenska University Hospital, Mölndal

dInstitute of Medicine, Department of Molecular and Clinical Medicine/Clinical physiology, Sahlgrenska University Hospital, Sahlgrenska Academy, Göteborg University, Sweden

Correspondence to Anna-Clara Collén, MD, Medicin/Geriatrik/Akutmottagning, Sahlgrenska Universitetssjukhuset/Östra, 41685 Göteborg, Sweden. Tel: +46 708 710420; fax: +46 31 259254; e-mail: anna-clara.collen@vgregion.se

Abbreviations: ABPM, ambulatory blood pressure measurements; ACE inhibitors, angiotensin-converting enzyme inhibitors; AIx, augmentation index; Ao DBP, central diastolic blood pressure; Ao SBP, central systolic blood pressure; HTP, hypertensive pregnancies; IMT, intima–media thickness; LVM, left ventricular mass; LVMi, left ventricular mass index; MI, myocardial infarction; NTP, normotensive pregnancies; PIH, pregnancy-induced hypertension; PWV, pulse wave velocity; RWT, relative wall thickness

Received 20 September, 2012

Revised 4 November, 2012

Accepted 20 December, 2012

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© 2013 Lippincott Williams & Wilkins, Inc.