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Cardiac risk factors and prevention
Original article
Left ventricular hypertrophy after hypertensive pregnancy disorders
  1. Dawn C Scantlebury1,
  2. Garvan C Kane1,
  3. Heather J Wiste2,
  4. Kent R Bailey2,
  5. Stephen T Turner3,
  6. Donna K Arnett4,
  7. Richard B Devereux5,
  8. Thomas H Mosley Jr6,
  9. Steven C Hunt7,
  10. Alan B Weder8,
  11. Beatriz Rodriguez9,
  12. Eric Boerwinkle10,
  13. Tracey L Weissgerber3,
  14. Vesna D Garovic3
  1. 1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
  4. 4University of Alabama at Birmingham, Birmingham, Alabama, USA
  5. 5Weill Cornell Medical College, New York, New York, USA
  6. 6University of Mississippi Medical Center, Jackson, Mississippi, USA
  7. 7University of Utah, Salt Lake City, Utah, USA
  8. 8University of Michigan, Ann Arbor, Michigan, USA
  9. 9University of Hawai'i, Honolulu, Hawai'i, USA
  10. 10University of Texas, Houston, Texas, USA
  1. Correspondence to Dr Vesna D Garovic, Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; garovic.vesna{at}mayo.edu

Abstract

Objective Cardiac changes of hypertensive pregnancy include left ventricular hypertrophy (LVH) and diastolic dysfunction. These are thought to regress postpartum. We hypothesised that women with a history of hypertensive pregnancy would have altered LV geometry and function when compared with women with only normotensive pregnancies.

Methods In this cohort study, we analysed echocardiograms of 2637 women who participated in the Family Blood Pressure Program. We compared LV mass and function in women with hypertensive pregnancies with those with normotensive pregnancies.

Results Women were evaluated at a mean age of 56 years: 427 (16%) had at least one hypertensive pregnancy; 2210 (84%) had normotensive pregnancies. Compared with women with normotensive pregnancies, women with hypertensive pregnancy had a greater risk of LVH (OR: 1.42; 95% CI 1.01 to 1.99, p=0.05), after adjusting for age, race, research network of the Family Blood Pressure Program, education, parity, BMI, hypertension and diabetes. When duration of hypertension was taken into account, this relationship was no longer significant (OR: 1.19; CI 0.08 to 1.78, p=0.38). Women with hypertensive pregnancies also had greater left atrial size and lower mitral E/A ratio after adjusting for demographic variables. The prevalence of systolic dysfunction was similar between the groups.

Conclusions A history of hypertensive pregnancy is associated with LVH after adjusting for risk factors; this might be explained by longer duration of hypertension. This finding supports current guidelines recommending surveillance of women following a hypertensive pregnancy, and sets the stage for longitudinal echocardiographic studies to further elucidate progression of LV geometry and function after pregnancy.

Clinical trial registrations GENOA- NCT00005269; HyperGEN- NCT00005267; Sapphire- NCT00005270; GenNet- NCT00005268.

https://doi.org/10.1136/heartjnl-2015-308098

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