Decades after blood pressure-related pregnancy complications, Hispanic/Latina women may experience changes in heart structure and function
Cardiac abnormalities in Hispanic/Latina women with previous de novo hypertensive disorders in pregnancy Background: Hypertensive disorders of pregnancy (HDP) are associated with long-term maternal risks of cardiovascular disease for reasons that are not yet fully understood. Methods: The HCHS/SOL (Hispanic Community Health Study/Study of Latinos), a multicenter community-based cohort of Hispanic/Latino adults recruited between 2008 and 2011, was used to evaluate the associations of history of de novo HDP (gestational hypertension, preeclampsia, eclampsia) with echocardiographic measures of cardiac structure and function in Hispanic/Latina women with ≥1 previous pregnancy and the proportion of association mediated by current hypertension (>140/90 mm Hg or antihypertensive therapy). Results: The study cohort included 5168 Hispanic/Latina women with a mean (SD) age of 58.7 (9.7) years at the time of echocardiogram. Previous de novo HDP was reported by 724 (14%) of the women studied and was associated with a lower left ventricular (LV) ejection fraction −0.66 (95% confidence interval [CI], −1.21 to − 0.11), higher relative LV wall thickness 0.09 (95% CI, 0–0.18) and 1.39 (95% CI, 1.02–1.89) increased risk of abnormal LV geometry VI after adjusting for blood pressure and other confounders. The proportion of current hypertension-mediated association between HDP and LV ejection fraction was 0.09 (95% CI, 0.03–0.45), relative LV wall thickness was 0.28 ( 95% CI, 0.16–0.51), abnormal LV geometry was 0.14 (95% CI, 0.12–0.48), left ventricular concentric hypertrophy was 0.31 (95% CI, 0.12–0.48). , 0.19–0.86) and abnormal LV diastolic dysfunction was 0.58 (95% CI, 0.26–0.79). Conclusions: In a large cohort of Hispanic/Latina women , those with a history of de novo HDP had detectable and measurable subclinical alterations in cardiac structure and both systolic and diastolic dysfunction that were only partially mediated by current hypertension. |
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According to a study supported by the National Institutes of Health. The findings, published in the journal Hypertension , while having high blood pressure later in life can contribute to these abnormalities, hypertension during pregnancy plays a larger role, significantly increasing a woman’s risk of developing a disease. cardiovascular.
"The changes in cardiac structure and function that this study uncovers are known predictors of cardiovascular events such as heart failure and even death," said Jasmina Varagic, Ph.D., program manager in the Vascular Biology and Hypertension branch at National Heart. Lung and Blood Institute (NHLBI), part of the NIH. "These findings emphasize the importance of recognizing high blood pressure during pregnancy as an important risk factor for these future problems, especially in this understudied population of women."
Rates of high blood pressure during pregnancy, including preeclampsia, eclampsia, and gestational hypertension , more than doubled between 2007 and 2019 in the US, with Hispanic/Latina women having the highest rate of more than 60 cases per every 1000 live births. Previous studies have shown that among women who have high blood pressure during pregnancy, up to 20% will continue to have high blood pressure six months after giving birth and will also have up to 10 times the risk of chronic high blood pressure during their lifetime. But researchers were unclear how high blood pressure during pregnancy was driving the high risk of cardiovascular disease that many of these women later developed.
"Before our study, the question was: Do abnormalities in heart structure and function develop because of high blood pressure during pregnancy itself, or because many of the women develop chronic high blood pressure afterwards?" asked Odayme Quesada, MD, medical director of The Christ Hospital Women’s Heart Center and lead author of the study. "Our study helps answer this question."
For the study, researchers used participants in the NHLBI-funded Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multicenter community-based cohort of Hispanic/Latino adults. The cohort included 5,168 women who had had at least one previous pregnancy and whose average age was 58.7 years (well beyond childbearing age) at the time of the study.
The participants underwent echocardiography to look for alterations in the structure and function of the heart, focusing on the left ventricle, considered the workhorse of the heart that pumps blood to the body. The researchers looked for alterations in the thickness and shape of the ventricle and how well the heart contracts and relaxes.
The researchers found that prior high blood pressure during pregnancy was associated with alterations in the way the heart contracts and relaxes, increased heart wall thickness, and higher rates of abnormal geometry in the left ventricle. These abnormalities, particularly in left ventricular geometry, are known to predict future cardiovascular events, including heart failure, ischemic heart disease, and sudden cardiac death.
The researchers also found that having high blood pressure later in life only accounted for part of the changes seen in heart structure and function. For example, they found that the hypertension experienced by women at the time of the study explained only 14% of the risk of having abnormal left ventricular geometry, while the rest was explained by having high blood pressure at the time of their pregnancies.
"This underscores the importance of early surveillance for cardiac abnormalities in women whose pregnancy is complicated by HTN, and also the importance of controlling high blood pressure to prevent cardiovascular disease in the future," Varagic said. She added that there is a need to further investigate the factors beyond blood pressure that link high blood pressure during pregnancy with heart abnormalities in later life.
