title: Disproportionate pregnancy-induced myocardial hypertrophy in women with essential hypertension.
abstract: BACKGROUND
  Pregnancy and arterial hypertension (AH) have a prohypertrophic effect on the heart. It is suspected that the 2 conditions combined cause disproportionate myocardial hypertrophy. We sought to evaluate myocardial hypertrophy (LVH) and left ventricular function in normotensive and hypertensive women in the presence or absence of pregnancy.
  
  
  METHODS
  This prospective cross-sectional study included 193 women divided into 4 groups: hypertensive pregnant (HTP; n = 57), normotensive pregnant (NTP; n = 47), hypertensive nonpregnant (HTNP; n = 41), and normotensive nonpregnant (NTNP; n = 48). After clinical and echocardiographic evaluation, the variables were analyzed using 2-way analysis of variance with pregnancy and hypertension as factors. Left ventricular mass (LVM) was compared using nonparametric analysis of variance and Dunn's test. Predictors of LVH and diastolic dysfunction were analyzed using logistic regression (significance level, P < 0.05).
  
  
  RESULTS
  Myocardial hypertrophy was independently associated with hypertension (odds ratio (OR) = 11.1, 95% confidence interval (CI) = 3.2-38.5; P < 0.001) and pregnancy (OR = 6.1, 95% CI = 2.6-14.3; P < 0.001) in a model adjusted for age and body mass index. Nonpregnant women were at greater risk of LVH in the presence of AH (OR = 25.3, 95% CI = 3.15-203.5; P = 0.002). The risk was additionally increased in hypertensive women during pregnancy (OR = 4.3, 95% CI = 1.7-10.9; P = 0.002) in the model adjusted for stroke volume and antihypertensive medication. Although none of the NTNP women presented with diastolic dysfunction, it was observed in 2% of the NTP women, 29% of the HTNP women, and 42% of the HTP women (P < 0.05).
  
  
  CONCLUSIONS
  Hypertension and pregnancy have a synergistic effect on ventricular remodeling, which elevates a woman's risk of myocardial hypertrophy.
authors.affiliation: Department of Internal Medicine, Botucatu Medical School-Unesp, São Paulo State University, São Paulo, Brazil. sgzanati@fmb.unesp.br
authors.forename: Silméia Garcia
authors.initials: SG
authors.lastname: Zanati Bazan
authors.forename: Veratherezinha Medeiros
authors.initials: VM
authors.lastname: Borges
authors.forename: Luís Cuadrado
authors.initials: LC
authors.lastname: Martin
authors.forename: Claudia Garcia
authors.initials: CG
authors.lastname: Magalhães
authors.forename: João Carlos
authors.initials: JC
authors.lastname: Hueb
authors.forename: Liciana Vaz
authors.initials: LV
authors.lastname: de Arruda Silveira
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Peraçoli
authors.forename: Beatriz Bojikian
authors.initials: BB
authors.lastname: Matsubara
mesh_terms: D000328:Adult; D001794:Blood Pressure; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D015994:Incidence; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011446:Prospective Studies; D016277:Ventricular Function, Left / Q000502:physiology*; D020257:Ventricular Remodeling
keywords: blood pressure; echocardiography; hypertension; pregnancy; pressure overload; ventricular function; ventricular remodeling.