Hypertensive Disorders of Pregnancy and Weight as Determinants of Chronic Hypert

[Argirios Argiriou]

August 4, 2017

Hypertensive Disorders of Pregnancy and Weight as Determinants of Chronic Hypertension

Robert L. Barbieri, MD Reviewing Timpka S et al., BMJ 2017 Jul 12; 358:j3024

As both factors raise risk for hypertension, consistently monitoring blood pressure and maintaining healthy weight are particularly important.

The association between hypertensive disorders of pregnancy (HDP) and subsequent chronic hypertension is well known, but the underlying mechanisms remain unclear. To assess the trajectory of risk for developing hypertension following a pregnancy complicated by HDP, investigators studied the health histories of 1,025,000 Danish women with ≥1 live birth or stillbirth between 1978 and 2012. For women with first pregnancy in their 20s, incidence of developing chronic hypertension within the first 10 years after delivery was 14% (with HDP) and 4% (without HDP). Among women with first pregnancy in their 40s, the corresponding incidences were 32% and 11%, respectively. Twofold higher rates of hypertension among women with HDP persisted more than 20 years later.

In the Nurses' Health Study (designed to assess lifestyle factors and risk for developing hypertension), 54,600 parous women (age range, 32–59) were studied prospectively. Being overweight or obese raised risk for developing chronic hypertension regardless of history of HDP. Levels of physical activity and sodium intake did not significantly modify the association between body-mass index (BMI) and risk for developing hypertension. After controlling for multiple variables, history of HDP plus elevated BMI increased risk for developing hypertension more than elevated BMI alone.

Comment

These studies confirm that a history of HDP, elevated BMI, or both raise risk for developing chronic hypertension. In practice, clinicians might not be aware that a patient has a history of HDP (especially 10 or 20 years after delivery). The electronic medical record system, given its widespread use, could serve as a valuable tool to highlight and permanently record HPD history, helping clinicians to identify women at excess risk for developing hypertension.

Editor Disclosures at Time of Publication

Disclosures for Robert L. Barbieri, MD at time of publication

Editorial boards

UpToDate; OBG Management

Citation(s):

Behrens I et al. Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy: Nationwide cohort study. BMJ 2017 Jul 12; 358:j3078. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

Timpka S et al. Lifestyle in progression from hypertensive disorders of pregnancy to chronic hypertension in Nurses' Health Study II: Observational cohort study. BMJ 2017 Jul 12; 358:j3024. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος