title: Cerebrovascular, cardiovascular and renal hypertensive disease after hypertensive disorders of pregnancy.
abstract: BACKGROUND
  Strong associations have been established in nationwide registry studies between hypertensive disorders of pregnancy (HDP) and later vascular morbidities and mortality. The aim of this case-control study is to examine the interdependent relationships of different predictive factors for vascular disease and HDP, because they are not clearly elucidated due to lack of detail in registries.
  
  
  RESULTS
  We assembled three different case groups of women who had cerebrovascular, cardiovascular, or hypertensive kidney disease before the age of 55. The control group consisted of age-matched women who underwent hysterectomy for benign reasons. We assessed the occurrence of HDP in previous pregnancies. The strength of the association with vascular morbidities was tested with multivariable logistic regression in comparison with classic vascular risk factors. In all case groups, previous HDP occurred more frequent than in the control group. In logistic regression analysis, previous HDP were the strongest predictor in the cerebrovascular group (OR 4.2; 95% confidence interval [CI] 1.6-11.0). In the cardiovascular group and the kidney failure group a similar association was found, however, this was not statistically significant (OR 4.4 (95% CI 0.82-4) and 2.9 (95% CI 0.61-14), respectively).
  
  
  CONCLUSIONS
  Previous hypertensive disorders of pregnancy are a strong predictor for later vascular morbidity. This is partially mediated through the presence of classic vascular risk factors, but our data suggest it is also an independent predictor.
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: s.a.schokker@amc.nl.
authors.forename: S A M
authors.initials: SA
authors.lastname: Schokker
authors.affiliation: Department of Obstetrics and Gynecology, Beatrixziekenhuis, Gorinchem, The Netherlands.
authors.forename: M F
authors.initials: MF
authors.lastname: Van Oostwaard
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: E M
authors.initials: EM
authors.lastname: Melman
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Van Kessel
authors.affiliation: Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: M I
authors.initials: MI
authors.lastname: Baharoglu
authors.affiliation: Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Y B W E M
authors.initials: YB
authors.lastname: Roos
authors.affiliation: Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Vogt
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: De Winter
authors.affiliation: The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Australia.
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Ganzevoort
mesh_terms: D000328:Adult; D002319:Cardiovascular System / Q000503:physiopathology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D006977:Hypertension, Renal / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology
keywords: Gestational hypertension; Hypertensive kidney failure; Percutaneous transluminal coronary angioplasty; Predictors; Preeclampsia; Stroke