Hypertensive diseases in pregnancy, cardiac structure and function later in life: Insights from the Genetic Epidemiology Network of Arteriopathy (GENOA) study

Echocardiographic Differences in Women Across Subtypes of Hypertensive Disorders of Pregnancy

Background

Hypertensive disorders of pregnancy (HDP) can be classified into gestational hypertension, preeclampsia (PRE), and chronic hypertension with superimposed preeclampsia (SPE).

Objectives

The purpose of this study was to retrospectively examine the echocardiographic differences in biventricular structure and function in 3 HDP groups of women in comparison to normotensive pregnant controls.

Methods

Women with an echocardiogram during or within the first year of pregnancy were identified within our integrated health network. Exclusion criteria included age <18 years, diagnosis of pulmonary embolism, malignancy, autoimmune disease, and structural heart disease.

Results

We identified a total of 706 subjects (cases: n = 427, normotensive controls: n = 279). Cases were divided into 3 groups: gestational hypertension (n = 57), PRE (n = 291), and SPE (n = 79). In adjusted analyses, echocardiographic parameters demonstrated a graded difference in left ventricular (LV) mass index, relative wall thickness, mitral inflow E, mitral inflow A, septal e', lateral e', E/e', left atrial volume index, tricuspid velocity, and lateral e' velocities with the most profound findings noted in the SPE group. Specifically, adjusted LV mass index (adjusted β = 14.45, 95% CI: 9.00-19.90) and E/e' (adjusted β = 2.97, 95% CI: 2.27-3.68) was highest in the SPE group in comparison to controls (P < 0.001).

Conclusions

LV remodeling and diastolic filling abnormalities are more common in HDP and are most evident in SPE and PRE. Echocardiography during or immediately after pregnancy may be useful in these high-risk women to identify these abnormalities. The long-term implications of these echocardiographic abnormalities require further study.

The Risk and Clinical Treatment of Hypertensive Diseases in Pregnant Women

Hypertensive disorders of pregnancy are a group of pregnancy-related diseases characterized by the coexistence of pregnancy and elevated blood pressure, which seriously endanger the health of mothers and infants, and are one of the main causes of maternal and perinatal deaths. The purpose of this paper is to investigate the clinical analysis of vitamin E and astragalus in the adjuvant treatment of hypertensive disorders in pregnancy and to describe the learning model. This paper puts forward the problem of clinical treatment, which is established on the basis of adjuvant therapy, then narrates around the clinical characteristics of gestational hypertension, and designs and analyzes the experimental design and analysis of adjuvant therapy with vitamin E and astragalus. The experimental results showed that the delivery methods of the three groups of patients were compared $P<0.05$ . Compared with the traditional Chinese medicine control group and the vitamin E control group, there were more vaginal births in the experimental group, 36 patients in total. It shows that astragalus and vitamin E can alleviate the disease in different aspects and can effectively intervene in gestational hypertension.

Hypertensive Diseases in Pregnancy and Kidney Function Later in Life: The Genetic Epidemiology Network of Arteriopathy (GENOA) Study

OBJECTIVE

To evaluate the relationship between hypertensive diseases in pregnancy and kidney function later in life.

METHODS

We evaluated measured glomerular filtration rate (mGFR) using iothalamate urinary clearance in 725 women of the Genetic Epidemiology Network of Arteriopathy (GENOA) study. Women were classified by self-report as nulliparous (n=62), a history of normotensive pregnancies (n=544), a history of hypertensive pregnancies (n=102), or a history of pre-eclampsia (n=17). We compared adjusted associations among these four groups with mGFR using generalized estimating equations to account for familial clustering. Chronic kidney disease (CKD) was defined as mGFR of less than 60 mL/min per 1.73 m² or urinary albumin-creatinine ratio (UACR) greater than or equal to 30 mg/g.

RESULTS

Among women with kidney function measurements (mean age, 59±9 years, 52.9% African American), those with a history of hypertensive pregnancy had lower mGFR (-4.66 ml/min per 1.73 m²; 95% CI, -9.12 to -0.20) compared with women with a history of normotensive pregnancies. Compared with women with a history of normotensive pregnancies, women with a history of hypertensive pregnancy also had higher odds of mGFR less than 60 ml/min per 1.73 m² (odds ratio, 2.09; 95% CI, 1.21 to 3.60). Additionally, women with a history of hypertensive pregnancy had greater odds for chronic kidney disease (odds ratio, 4.89; 95% CI, 1.55 to 15.44), after adjusting for age, race, education, smoking history, hypertension, body mass index, and diabetes.

CONCLUSION

A history of hypertension in pregnancy is an important prognostic risk factor for kidney disease. To our knowledge, this is the first and largest investigation showing the association between hypertensive diseases in pregnancy and subsequent kidney disease using mGFR in a large biracial cohort.

Severe Preeclampsia is Associated with Functional and Structural Cardiac Alterations: A Case-control Study

BACKGROUND

The aim of the current study is to compare electrocardiographic and echocardiographic changes in patients with severe preeclampsia (PE) and those with uncomplicated pregnancies.

METHODS

This is a case-controlled prospective study consisting of 21 pregnant women with severe preeclampsia and a control group consisting of age- and gestational age-matched 24 healthy pregnant women. All patients underwent electrocardiographic and echocardiographic investigation.

RESULTS

QRS intervals were shorter and PR intervals were longer in the PE group (QRS duration: 80 (60-120) ms and 80 (40-110) ms, p=0.035; PR duration: 160 (100-240) ms and 120 (80-200) ms, respectively; p=0.046). The left ventricular end-systolic diameters of the patients with severe PE group were significantly larger than the control group (31 (24-36) mm and 30 (24-33) mm, respectively; p=0.05). Similarly, posterior wall thickness values of the PE group were significantly higher compared to the control group (9 (7-11) mm vs. 8 (6-10) mm, respectively; p=0.020). Left ventricular mass (146.63±27.73 g and 128.69±23.25 g, respectively; p=0.033) and relative wall thickness values (0.385±0.054 and 0.349±0.046, respectively; p=0.030) were also higher in the PE group. In addition, patients with early-onset severe PE had significantly a higher left ventricular end-diastolic diameter and volume compared with late-onset PE patients.

CONCLUSIONS

The structural changes detected in the severe PE group suggest a chronic process rather than an acute effect. In addition, diastolic dysfunction and left ventricular remodeling are most marked in patients with severe early-onset PE.