title: Hypertension after preeclampsia is preceded by changes in cardiac structure and function.
abstract: Preeclampsia is associated with a 4-fold higher risk for developing remote chronic hypertension. Preeclampsia is accompanied by left ventricular hypertrophy and decreased diastolic function, which may or may not resolve postpartum. We tested the hypothesis that increased measures of cardiac geometry and decreased cardiac function persisting for ≥ 6 months postpartum in normotensive women with a history of preeclampsia precede the development of later chronic hypertension. Formerly preeclamptic women (n=652) underwent echocardiography at 9 months (range, 6-19) postpartum. We excluded women with preexisting hypertension (n=42), hypertension at the postpartum screening (n=133), and those that did not return any checklist (n=128). Eventually, 349 women were included. Remote health was evaluated by a biennially checklist. We used Cox regression for analysis. Twenty-seven (8%) normotensive women had developed chronic hypertension during a medium follow-up period of 6 years. At screening they differed from their counterparts who remained normotensive by hazard ratio for left ventricular mass index (1.11; 95% confidence interval [CI], 1.03-1.18), diastolic blood pressure (1.13; 95% CI, 1.06-1.20), systolic blood pressure (1.07; 95% CI, 1.02-1.11), mean arterial pressure (1.11; 95% CI, 1.05-1.18), heart rate (1.05; 95% CI, 1.01-1.10), and E/A ratio (0.22; 95% CI, 0.06-0.85). Backward stepwise analysis showed independent hazard ratio for left ventricular mass index and diastolic blood pressure 1.08 (95% CI, 1.01-1.16) and 1.13 (95% CI, 1.06-1.21), respectively. In conclusion, the development of later chronic hypertension in initially normotensive formerly preeclamptic women is preceded by increased left ventricular mass index and diastolic blood pressure at postpartum screening.
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, The Netherlands. c.ghossein@maastrichtuniversity.nl
authors.forename: Chahinda
authors.initials: C
authors.lastname: Ghossein-Doha
authors.forename: Louis
authors.initials: L
authors.lastname: Peeters
authors.forename: Sanne
authors.initials: S
authors.lastname: van Heijster
authors.forename: Sander
authors.initials: S
authors.lastname: van Kuijk
authors.forename: Julia
authors.initials: J
authors.lastname: Spaan
authors.forename: Tammo
authors.initials: T
authors.lastname: Delhaas
authors.forename: Marc
authors.initials: M
authors.lastname: Spaanderman
mesh_terms: D002908:Chronic Disease; D003971:Diastole; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D017379:Hypertrophy, Left Ventricular / Q000209:etiology*; D011225:Pre-Eclampsia / Q000473:pathology / Q000503:physiopathology*; D011247:Pregnancy; D016016:Proportional Hazards Models; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000209:etiology*
keywords: cardiovascular diseases; echocardiography; hypertension; preeclampsia; prehypertension; ventricular remodeling