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Title: Hypertension During Pregnancy Heightens Risk Of Later Cardiovascular Problems

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BMJ 2003;326:845-9.
04/17/2003 07:03:00 PM
By Harvey McConnell

Women who had hypertension during pregnancy have an increased risk of developing cardiovascular disease in later life, say Scottish researchers. These women also have an increased risk of stroke and, to a lesser extent, ischaemic heart disease, found Dr Cairns Smith and colleagues at the University of Aberdeen, Scotland. Long-term cardiovascular risks were greatest for women who had pre-eclampsia. Almost 30% of first pregnancies are thought to be affected by gestational (transient) hypertension, pre-eclampsia, or eclampsia, the clinicians point out. But, there has been relatively little research about long term effects. Dr Smith and colleagues, in a retrospective cohort study, used the Aberdeen maternity and neonatal databank to gather data on 3,593 women, mean age of 24.2 at delivery, who had pre-eclampsia during their first singleton pregnancy. Two comparison groups were matched for age and year of delivery: one with gestational hypertension, and one with no history of raised blood pressure. The clinicians found a significant positive associations between pre-eclampsia/eclampsia, or gestational hypertension, and later hypertension in all measures. The adjusted relative risks varied from 1.13-3.72 for gestational hypertension, and 1.40-3.98 for pre-eclampsia or eclampsia. The adjusted incident rate ratio for death from stroke for the pre-eclampsia/eclampsia group was 3.59. Women in the gestational hypertension group were more likely to have been admitted to hospital for cerebrovascular disease, ischaemic heart disease, hypertension, and other circulatory disease, although this reached significance only for hypertension and other circulatory disease. Women in the pre-eclampsia or eclampsia group were also more likely to be admitted for hypertension, cerebrovascular disease, and other circulatory disease. "We found an increased risk of admission to hospital for stroke and mortality from stroke but no significant increased risk of morbidity and mortality from coronary heart disease as has previously been reported, "Dr Smith and colleagues added. They think their findings cannot be explained by chance or bias, and "have implications for the aetiology and pathogenesis of circulatory disease, both in pregnancy and in later life. They also suggest that interventions that might minimise the risk of such conditions in later life should be identified and evaluated."

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