BMJ 2003;326:845 ( 19 April )

Papers

Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study

Brenda J Wilson, senior lecturer, a M Stuart Watson, lecturer, a Gordon J Prescott, research fellow in medical statistics, a Sarah Sunderland, research nurse, a Doris M Campbell, reader, b Philip Hannaford, professor, c W Cairns S Smith, professor. a

a Department of Public Health, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, b Department of Obstetrics and Gynaecology, University of Aberdeen, c Department of General Practice and Primary Care, University of Aberdeen

Correspondence to: W C S Smith w.c.s.smith{at}abdn.ac.uk

Objective: To examine the association between hypertensive diseases of pregnancy (gestational hypertension and pre-eclampsia) and the development of circulatory diseases in later life.
Design: Cohort study of women 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.
Setting: Maternity services in the Grampian region of Scotland.
Participants: Women selected from the Aberdeen maternity and neonatal databank who were resident in Aberdeen and who delivered a first, live singleton from 1951 to 1970.
Main outcome measures: Current vital and cardiovascular health status ascertained through postal questionnaire survey, clinical examination, linkage to hospital discharge, and mortality data.
Results: There were 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 (95% confidence interval 1.04 to 12.4).
Conclusions: Hypertensive diseases of pregnancy seem to be associated in later life with diseases related to hypertension. If greater awareness of this association leads to earlier diagnosis and improved management, there may be scope for reducing a proportion of the morbidity and mortality from such diseases.

What is already known on this topic
Much is known about the effect of cardiovascular risks factors that are shared by men and women, but less on those specific to women

Retrospective studies, based on patient recall, suggest that hypertension in pregnancy may be associated with increased risk of cardiovascular diseases in later life

What this study adds
Prospective recording of blood pressure and proteinuria shows that women who experienced raised blood pressure in pregnancy have a long term risk of hypertension

Women who experience raise blood pressure in pregnancy have an increased risk of stroke and, to a lesser extent, an increased risk of ischaemic heart disease

Long term cardiovascular risks are greater for women who had pre-eclampsia than those who experienced gestational hypertension (hypertension without proteinuria)




© 2003 BMJ Publishing Group Ltd
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Articles

Prepregnancy cardiovascular risk factors as predictors of pre-eclampsia: population based cohort study
Elisabeth Balstad Magnussen, Lars Johan Vatten, Tom Ivar Lund-Nilsen, Kjell Åsmund Salvesen, George Davey Smith, and Pål Richard Romundstad
BMJ 2007 335: 978. [Abstract] [Full Text] [PDF]

Hypertension in pregnancy may persist
BMJ 2003 326: 0. [Full Text]

This article has been cited by other articles:

  • Bernstein, I. M., Damron, D., Schonberg, A. L., Shapiro, R. (2009). The Relationship of Plasma Volume, Sympathetic Tone, and Proinflammatory Cytokines in Young Healthy Nonpregnant Women. Reproductive Sciences 16: 980-985 [Abstract]  
  • Zhang, X., Shu, X.-O., Gao, Y.-T., Yang, G., Li, H., Zheng, W. (2009). Pregnancy, Childrearing, and Risk of Stroke in Chinese Women. Stroke 40: 2680-2684 [Abstract] [Full text]  
  • Robb, A. O., Mills, N. L., Din, J. N., Smith, I. B.J., Paterson, F., Newby, D. E., Denison, F. C. (2009). Influence of the Menstrual Cycle, Pregnancy, and Preeclampsia on Arterial Stiffness. Hypertension 53: 952-958 [Abstract] [Full text]  
  • Lykke, J. A., Langhoff-Roos, J., Sibai, B. M., Funai, E. F., Triche, E. W., Paidas, M. J. (2009). Hypertensive Pregnancy Disorders and Subsequent Cardiovascular Morbidity and Type 2 Diabetes Mellitus in the Mother. Hypertension 53: 944-951 [Abstract] [Full text]  
  • Tang, C.-H., Wu, C.-S., Lee, T.-H., Hung, S.-T., Yang, C.-Y. C., Lee, C.-H., Chu, P.-H. (2009). Preeclampsia-Eclampsia and the Risk of Stroke Among Peripartum in Taiwan. Stroke 40: 1162-1168 [Abstract] [Full text]  
  • Valdes, G., Quezada, F., Marchant, E., von Schultzendorff, A., Moran, S., Padilla, O., Martinez, A. (2009). Association of Remote Hypertension in Pregnancy With Coronary Artery Disease: A Case-Control Study. Hypertension 53: 733-738 [Abstract] [Full text]  
  • Champagne, K., Schwartzman, K., Opatrny, L., Barriga, P., Morin, L., Mallozzi, A., Benjamin, A., Kimoff, R. J. (2009). Obstructive sleep apnoea and its association with gestational hypertension. Eur Respir J 33: 559-565 [Abstract] [Full text]  
  • Dragun, D., Haase-Fielitz, A. (2009). Low catechol-O-methyltransferase and 2-methoxyestradiol in preeclampsia: more than a unifying hypothesis. Nephrol Dial Transplant 24: 31-33 [Full text]  
  • Mistry, H. D., Wilson, V., Ramsay, M. M., Symonds, M. E., Pipkin, F. B. (2008). Reduced Selenium Concentrations and Glutathione Peroxidase Activity in Preeclamptic Pregnancies. Hypertension 52: 881-888 [Abstract] [Full text]  
  • Silva, L. M., Steegers, E. A.P., Burdorf, A., Jaddoe, V. W.V., Arends, L. R., Hofman, A., Mackenbach, J. P., Raat, H. (2008). No Midpregnancy Fall in Diastolic Blood Pressure in Women With a Low Educational Level: The Generation R Study. Hypertension 52: 645-651 [Abstract] [Full text]  
  • Vikse, B. E., Irgens, L. M., Leivestad, T., Skjaerven, R., Iversen, B. M. (2008). Preeclampsia and the Risk of End-Stage Renal Disease. NEJM 359: 800-809 [Abstract] [Full text]  
  • Thadhani, R., Solomon, C. G. (2008). Preeclampsia -- A Glimpse into the Future?. NEJM 359: 858-860 [Full text]  
  • Craici, I., Wagner, S., Garovic, V. D. (2008). Review: Preeclampsia and future cardiovascular risk: formal risk factor or failed stress test?. Ther Adv Cardiovasc Dis 2: 249-259 [Abstract]  
  • Lampinen, K. H., Ronnback, M., Groop, P.-H., Kaaja, R. J. (2008). A Relationship Between Insulin Sensitivity and Vasodilation in Women With a History of Preeclamptic Pregnancy. Hypertension 52: 394-401 [Abstract] [Full text]  
  • Krabbendam, I., Janssen, B. J., Van Dijk, A. P. J., Jongsma, H. W., Oyen, W. J. G., Lotgering, F. K., Spaanderman, M. E. A. (2008). The Relation Between Venous Reserve Capacity and Low Plasma Volume. Reproductive Sciences 15: 604-612 [Abstract]  
  • Treadwell, S D, Thanvi, B, Robinson, T G (2008). Stroke in pregnancy and the puerperium. Postgrad. Med. J. 84: 238-245 [Abstract] [Full text]  
  • Magnussen, E. B., Vatten, L. J., Lund-Nilsen, T. I., Salvesen, K. A., Smith, G. D., Romundstad, P. R. (2007). Prepregnancy cardiovascular risk factors as predictors of pre-eclampsia: population based cohort study. BMJ 335: 978-978 [Abstract] [Full text]  
  • Callaway, L. K., McIntyre, H. D., O'Callaghan, M., Williams, G. M., Najman, J. M., Lawlor, D. A. (2007). The Association of Hypertensive Disorders of Pregnancy with Weight Gain over the Subsequent 21 Years: Findings from a Prospective Cohort Study. Am J Epidemiol 166: 421-428 [Abstract] [Full text]  
  • Klemmensen, A. K., Olsen, S. F., Osterdal, M. L., Tabor, A. (2007). Validity of Preeclampsia-related Diagnoses Recorded in a National Hospital Registry and in a Postpartum Interview of the Women. Am J Epidemiol 166: 117-124 [Abstract] [Full text]  
  • Carpenter, M. W. (2007). Gestational Diabetes, Pregnancy Hypertension, and Late Vascular Disease. Diabetes Care 30: S246-S250 [Full text]  
  • Authors/Task Force Members:, , Mancia, G., De Backer, G., Dominiczak, A., Cifkova, R., Fagard, R., Germano, G., Grassi, G., Heagerty, A. M., Kjeldsen, S. E., Laurent, S., Narkiewicz, K., Ruilope, L., Rynkiewicz, A., Schmieder, R. E., Struijker Boudier, H. A.J., Zanchetti, A., ESC Committee for Practice Guidelines (CPG):, , Vahanian, A., Camm, J., De Caterina, R., Dean, V., Dickstein, K., Filippatos, G., Funck-Brentano, C., Hellemans, I., Kristensen, S. D., McGregor, K., Sechtem, U., Silber, S., Tendera, M., Widimsky, P., Zamorano, J. L., ESH Scientific Council:, , Kjeldsen, S. E., Erdine, S., Narkiewicz, K., Kiowski, W., Agabiti-Rosei, E., Ambrosioni, E., Cifkova, R., Dominiczak, A., Fagard, R., Heagerty, A. M., Laurent, S., Lindholm, L. H., Mancia, G., Manolis, A., Nilsson, P. M., Redon, J., Schmieder, R. E., Struijker-Boudier, H. A.J., Viigimaa, M., Document Reviewers:, , Filippatos, G., Adamopoulos, S., Agabiti-Rosei, E., Ambrosioni, E., Bertomeu, V., Clement, D., Erdine, S., Farsang, C., Gaita, D., Kiowski, W., Lip, G., Mallion, J.-M., Manolis, A. J., Nilsson, P. M., O'Brien, E., Ponikowski, P., Redon, J., Ruschitzka, F., Tamargo, J., van Zwieten, P., Viigimaa, M., Waeber, B., Williams, B., Zamorano, J. L. (2007). 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 0: ehm236v1-75 [Full text]  
  • Sabour, S., Franx, A., Rutten, A., Grobbee, D. E., Prokop, M., Bartelink, M.-L., van der Schouw, Y. T., Bots, M. L. (2007). High Blood Pressure in Pregnancy and Coronary Calcification. Hypertension 49: 813-817 [Abstract] [Full text]  
  • Mosca, L., Banka, C. L., Benjamin, E. J., Berra, K., Bushnell, C., Dolor, R. J., Ganiats, T. G., Gomes, A. S., Gornik, H. L., Gracia, C., Gulati, M., Haan, C. K., Judelson, D. R., Keenan, N., Kelepouris, E., Michos, E. D., Newby, L. K., Oparil, S., Ouyang, P., Oz, M. C., Petitti, D., Pinn, V. W., Redberg, R. F., Scott, R., Sherif, K., Smith, S. C. Jr, Sopko, G., Steinhorn, R. H., Stone, N. J., Taubert, K. A., Todd, B. A., Urbina, E., Wenger, N. K., Expert Panel/Writing Group, (2007). Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. J Am Coll Cardiol 49: 1230-1250 [Full text]  
  • Mosca, L., Banka, C. L., Benjamin, E. J., Berra, K., Bushnell, C., Dolor, R. J., Ganiats, T. G., Gomes, A. S., Gornik, H. L., Gracia, C., Gulati, M., Haan, C. K., Judelson, D. R., Keenan, N., Kelepouris, E., Michos, E. D., Newby, L. K., Oparil, S., Ouyang, P., Oz, M. C., Petitti, D., Pinn, V. W., Redberg, R. F., Scott, R., Sherif, K., Smith, S. C. Jr, Sopko, G., Steinhorn, R. H., Stone, N. J., Taubert, K. A., Todd, B. A., Urbina, E., Wenger, N. K., for the Expert Panel/Writing Group, (2007). Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation 115: 1481-1501 [Full text]  
  • Robb, A. O, Mills, N. L, Newby, D. E, Denison, F. C (2007). Endothelial progenitor cells in pregnancy. Reproduction 133: 1-9 [Abstract] [Full text]  
  • Tanaka, M., Jaamaa, G., Kaiser, M., Hills, E., Soim, A., Zhu, M., Shcherbatykh, I. Y., Samelson, R., Bell, E., Zdeb, M., McNutt, L.-A. (2007). Racial Disparity in Hypertensive Disorders of Pregnancy in New York State: A 10-Year Longitudinal Population-Based Study. AJPH 97: 163-170 [Abstract] [Full text]  
  • Bushnell, C. D., Hurn, P., Colton, C., Miller, V. M., del Zoppo, G., Elkind, M. S.V., Stern, B., Herrington, D., Ford-Lynch, G., Gorelick, P., James, A., Brown, C. M., Choi, E., Bray, P., Newby, L. K., Goldstein, L. B., Simpkins, J. (2006). Advancing the Study of Stroke in Women: Summary and Recommendations for Future Research From an NINDS-Sponsored Multidisciplinary Working Group. Stroke 37: 2387-2399 [Abstract] [Full text]  
  • Paradisi, G., Biaggi, A., Savone, R., Ianniello, F., Tomei, C., Caforio, L., Caruso, A. (2006). Cardiovascular Risk Factors in Healthy Women with Previous Gestational Hypertension. J. Clin. Endocrinol. Metab. 91: 1233-1238 [Abstract] [Full text]  
  • Brown, D. W., Dueker, N., Jamieson, D. J., Cole, J. W., Wozniak, M. A., Stern, B. J., Giles, W. H., Kittner, S. J. (2006). Preeclampsia and the Risk of Ischemic Stroke Among Young Women: Results From the Stroke Prevention in Young Women Study. Stroke 37: 1055-1059 [Abstract] [Full text]  
  • Kaaja, R. J., Greer, I. A. (2005). Manifestations of Chronic Disease During Pregnancy. JAMA 294: 2751-2757 [Abstract] [Full text]  
  • Scher, A. I., Terwindt, G. M., Picavet, H. S.J., Verschuren, W. M.M., Ferrari, M. D., Launer, L. J. (2005). Cardiovascular risk factors and migraine: The GEM population-based study. Neurology 64: 614-620 [Abstract] [Full text]  
  • Lawlor, D. A, Morton, S. M B, Nitsch, D., Leon, D. A (2005). Association between childhood and adulthood socioeconomic position and pregnancy induced hypertension: results from the Aberdeen children of the 1950s cohort study. J. Epidemiol. Community Health 59: 49-55 [Abstract] [Full text]  
  • Kaaja, R., Kinnunen, T., Luoto, R. (2005). Regional differences in the prevalence of pre-eclampsia in relation to the risk factors for coronary artery disease in women in Finland. Eur Heart J 26: 44-50 [Abstract] [Full text]  
  • James, P R., Nelson-Piercy, C. (2004). Management of hypertension before, during, and after pregnancy. Heart 90: 1499-1504 [Full text]  
  • Davison, J. M., Homuth, V., Jeyabalan, A., Conrad, K. P., Karumanchi, S. A., Quaggin, S., Dechend, R., Luft, F. C. (2004). New Aspects in the Pathophysiology of Preeclampsia. J. Am. Soc. Nephrol. 15: 2440-2448 [Abstract] [Full text]  
  • Pouta, A., Hartikainen, A.-L., Sovio, U., Gissler, M., Laitinen, J., McCarthy, M. I., Ruokonen, A., Elliott, P., Jarvelin, M.-R. (2004). Manifestations of Metabolic Syndrome After Hypertensive Pregnancy. Hypertension 43: 825-831 [Abstract] [Full text]  
  • Malik, I. (2003). JournalScan. Heart 89: 959-960 [Full text]  

Rapid Responses:

Read all Rapid Responses

A hypertensive pregnancy can warn of inflammatory disease later in life
Trevor G Marshall
bmj.com, 19 Apr 2003 [Full text]
Eclampsia is not a sign of latent hypertension
Monika Malhotra, et al.
bmj.com, 20 Apr 2003 [Full text]
Pregnancy: Women's Stress Test
Carlos E Poli de Figueiredo, et al.
bmj.com, 26 Apr 2003 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ