High Blood Pressure in Pregnancy and Coronary Calcification

Abstract

Abstract-A considerable proportion of pregnant women develop high blood pressure in pregnancy. Although it is assumed that this condition subsides after pregnancy, many of these women develop the metabolic syndrome later in life and are at increased risk to develop coronary heart disease. Atherosclerosis development is considered in between risk factors and occurrence of vascular symptoms. We set out to cross-sectionally study the relation of high blood pressure during pregnancy with risk of coronary calcification. The study population was composed 491 healthy postmenopausal women selected from a population-based cohort study. Information on high blood pressure during pregnancy was obtained using a questionnaire. ypertensive disorders are common complications of pregnancy and rank among the leading causes of maternal and perinatal morbidity and mortality worldwide. 1-3 Depending on the definitions used and the populations studied, high blood pressure is reported to affect 2% to 35% of all pregnancies. 4 In the various classification schemes proposed, hypertension specific for and secondary to pregnancy is referred to as gestational hypertension, pregnancy-induced hypertension, or, when proteinuria is observed as well, pre-eclampsia. Pre-eclampsia, in particular, is associated with an increased risk of adverse pregnancy outcome for both the mother and the fetus.During the last decade, evidence has accumulated that hypertensive disorders of pregnancy, pre-eclampsia, in particular, are associated with future hypertension and cardiovascular events. Pre-eclampsia and cardiovascular disease (CVD) share chronic hypertension, increased total cholesterol, decreased insulin sensitivity, and increased body mass index as common risk factors. 5 Large epidemiological studies have demonstrated that women who have had pre-eclampsia are at high (2-fold) risk to develop CVD in later life. 6 -11 Many of the women who have had pre-eclampsia in pregnancy and who have no signs of clinical disease after pregnancy exhibit the phenotype of the metabolic syndrome (overweight, latent hypertension, dyslipidemia, insulin resistance, and hyperhomocysteinemia) and impaired endothelial function at 3 to 12 months postpartum. [12][13][14][15] Apparently, exposure of the women with this phenotype to the additional metabolic and cardiovascular challenges of pregnancy induces transient clinical disease (ie, pre-eclampsia) that subsides after pregnancy but is likely to re-emerge later in life as CVD. 16 -18 This knowledge has lead to the novel concept of pregnancy as a cardiovascular challenge test with the development of high blood pressure or pre-eclampsia as a marker of increased risk to develop atherosclerosis and vascular events in the future. To further expand on this notion toward the development of atherosclerosis, we studied the relation of high blood pressure during pregnancy with coronary atherosclerosis. Increased coronary calcium is indeed one of the strongest predictors of

Hypertension during Pregnancy is Associated with Coronary Artery Calcium Independent of Renal Function

“…Previously, a significant association between HDP and the presence of CAC was found in the Predictors of Response to Cardiac Resynchronization Therapy (PROSPECT) Study; however, PROSPECT did not investigate HDP's association with CAC extent nor were measures of renal function considered. 39 Here, we have extended the findings from the PROSPECT Study. In addition, the ECAC Study also had some information on preeclampsia.…”

“…We fit an unadjusted model; a model adjusted for age; a model adjusted for age, waist=hip ratio, DBP, and SBP; and finally, a model additionally adjusted for BMI, as done by others. 39 We then examined whether measures of renal function altered the association of HDP with CAC presence by fitting a logistic regression model additionally including ln(SCr) and ln(UACR). The final model considered also included diabetes status, menopause status, and BP-lowering medication use.…”

Determinants of future cardiovascular health in women with a history of preeclampsia

“…[46,48,[68][69][70][71][72][73] Two retrospective cohort studies have evaluated CACS in women with a history of hypertensive pregnancy disorders, and both found a positive association between CACS and self-reported hypertension in pregnancy. [74,75] There are no published prospective studies yet to evaluate CACS in previous preeclamptic patients. Although CACS is a non-invasive measurement, holds great promise as a CVD risk marker, and provides the most direct evidence for cardiovascular damage, radiation dose and costs should be taken into account when considering CACS for risk assessment.…”

Recent Progress Toward the Understanding of the Pathophysiology of Hypertension During Preeclampsia

“…[1][2][3][4][5][6][7][8][9][10][11] These alterations in vascular function not only lead to hypertension but multi-organ dysfunction, especially in women with early onset preeclampsia. 1,4,[11][12][13][14][15][16][17][18][19][20] Preterm preeclampsia remains a leading cause of maternal death and perinatal morbidity. Moreover, it has recently been recognized that women who endure preeclampsia are at a greater risk for cardiovascular disease later in life.…”