Association of Hypertensive Disorders of Pregnancy With Left Ventricular Remodeling Later in Life

Abstract

Background: Hypertensive disorders of pregnancy (HDP) are associated with short-term cardiac structure and function abnormalities, but later life changes are not well studied.

Objectives: This study aimed to determine if HDP history is associated with echocardiographic differences 8 to 10 years after delivery, and if subgroups with placental maternal vascular malperfusion (MVM) lesions or current hypertension may be particularly affected.

Methods: Women with pregnancies delivered from 2008 to 2009 were selected from a clinical cohort with abstracted pregnancy and placental pathology data to undergo transthoracic echocardiography (2017 to 2020). Medical history, blood pressure, and weight were measured at the study visit.

Results: The authors enrolled 132 women (10 ± 1 years post-delivery, age 38 ± 6 years): 102 with normotensive pregnancies and 30 with HDP: pre-eclampsia (n = 21) or gestational hypertension (n = 9). Compared with women with normotensive pregnancies, those with HDP history were more likely to have current hypertension (63% vs. 26%; p < 0.001). After adjusting for age, race, MVM lesions, body mass index, current hypertension, and hemoglobin A1c, women with HDP history had higher interventricular septal thickness (β = 0.08; p = 0.04) and relative wall thickness (β = 0.04; p = 0.04). In subgroup analyses, those with both HDP history and current hypertension had a higher proportion of left ventricular remodeling (79.0%) compared with all other groups (only HDP [36.4%; p = 0.01], only current hypertension [46.2%; p = 0.02], and neither HDP nor hypertension [38.2%; p < 0.001]), and lower mitral inflow E/A and annular e'. Accounting for placental MVM lesions did not impact results.

Conclusions: Women with both HDP history and current hypertension have pronounced differences in left ventricular structure and function a decade after pregnancy, warranting continued surveillance and targeted therapies for cardiovascular disease prevention.

Keywords: echocardiogram; hypertension; left ventricular remodeling; pre-eclampsia; pregnancy.

Figure 1.. Selected Echocardiographic Parameters Stratified by HDP History and Current Hypertension.

Between group post hoc pairwise comparisons of selected echocardiographic parameters, demonstrated as box plots of mean ± standard deviation, for those with or without HDP history and with or without current hypertension. A. Between group comparison of left ventricular interventricular septal wall thickness; B. Between group comparison of septal e’ mitral annular velocity; C. Between group comparison of relative wall thickness; D. Between group comparison of mitral inflow E/A ratio; IVS=interventricular septum, RWT=relative wall thickness.

Central Illustration:. Echocardiographic Differences among Women with Both Hypertensive Disorder of Pregnancy History and Current Hypertension 8–10 Years after Delivery.

Women with and without a history of a hypertensive disorder of pregnancy and with and without current hypertension underwent transthoracic echocardiogram 8–10 years after index pregnancy delivery (n=132). Women with both hypertensive disorder of pregnancy history and current hypertension (n=19) had the most adverse echocardiogram findings including increased interventricular septal wall thickness, higher percentage of LV remodeling (RWT of > 0.42), and adverse diastolic function parameters including a decreased mitral inflow E/A ratio (all p-values < 0.05 compared with those without a prior hypertensive disorder of pregnancy and without current hypertension). This suggests a “double-hit” phenomenon; women with prior hypertensive disorder of pregnancy and current hypertension are a high-risk group that warrants closer surveillance and targeted therapies for cardiovascular disease prevention. LV = left ventricular, RWT=relative wall thickness