Peripartum Screening for Postpartum Hypertension in Women With Hypertensive Disorders of Pregnancy,Journal of the American College of Cardiology

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Peripartum Screening for Postpartum Hypertension in Women With Hypertensive Disorders of Pregnancy
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2022-10-03 , DOI: 10.1016/j.jacc.2022.07.028
Veronica Giorgione ₁ , Asma Khalil ₁ , Jamie O'Driscoll ₂ , Basky Thilaganathan ₁

Affiliation

Background

Chronic hypertension (CHT) is the main risk factor for cardiovascular diseases in women with a history of hypertensive disorders of pregnancy (HDP).

Objectives

This study sought to assess the effectiveness of peripartum screening in predicting CHT after HDP.

Methods

In this longitudinal prospective study, women with HDP underwent peripartum transthoracic echocardiography and were evaluated for CHT (blood pressure ≥140/90 mm Hg or on antihypertensive medication) at least 3 months postpartum. Univariable and multivariable analyses assessed the association between clinical and transthoracic echocardiography data and a postpartum diagnosis of CHT.

Results

At a median postpartum follow-up of 124 days (IQR: 103-145 days), 70 (33.2%) of 211 women remained hypertensive. Compared with normotensive women, women with CHT were older (35.5 ± 5.0 years vs 32.9 ± 5.6 years; P = 0.001), were more likely to be Afro-Caribbean (27.1% vs 7.8%; P < 0.0001), had higher body mass index (33.4 ± 5.9 kg/m² vs 31.2 ± 5.4 kg/m²; P = 0.006), and had higher mean arterial pressure (106.5 ± 8.4 mm Hg vs 103.3 ± 7.0 mm Hg; P = 0.004). Moreover, they showed significantly higher left ventricular mass index (84.0 ± 17.9 g/m² vs 76.3 ± 14.8 g/m²; P = 0.001), higher relative wall thickness (0.46 ± 0.10 vs 0.40 ± 0.10; P < 0.0001), and lower global longitudinal strain (–15.6% ± 2.7% vs –16.6% ± 2.2%; P = 0.006) than normotensive women. A prediction model combining clinical (maternal age and first trimester mean arterial pressure) and echocardiographic features (left ventricular mass index >75 g/m², relative wall thickness >0.42, and E/e′ ratio >7) showed excellent accuracy in identifying women with persistent hypertension after HDP (area under the curve: 0.85; 95% CI: 0.79-0.90).

Conclusions

This peripartum screening approach might be used to identify women at risk of CHT who would benefit from intensive blood pressure monitoring and pharmacological strategies from the early postpartum period to prevent cardiovascular disease.

中文翻译：

妊娠期高血压疾病妇女产后高血压的围产期筛查

背景

慢性高血压（CHT）是有妊娠期高血压疾病（HDP）病史的女性心血管疾病的主要危险因素。

目标

本研究旨在评估围产期筛查在预测 HDP 后 CHT 的有效性。

方法

在这项纵向前瞻性研究中，患有 HDP 的女性在产后至少 3 个月接受了围产期经胸超声心动图检查并评估了 CHT（血压≥140/90 mm Hg 或服用抗高血压药物）。单变量和多变量分析评估了临床和经胸超声心动图数据与产后 CHT 诊断之间的关联。

结果

在 124 天（IQR：103-145 天）的中位产后随访中，211 名女性中有 70 名（33.2%）仍然患有高血压。与血压正常的女性相比，患有 CHT 的女性年龄更大（35.5 ± 5.0 岁 vs 32.9 ± 5.6 岁；P = 0.001），更有可能是非洲裔加勒比人（27.1% vs 7.8%；P < 0.0001），体重更高指数（33.4 ± 5.9 kg/m ² vs 31.2 ± 5.4 kg/m ²；P = 0.006），并且平均动脉压更高（106.5 ± 8.4 mm Hg vs 103.3 ± 7.0 mm Hg；P = 0.004）。此外，他们的左心室质量指数显着升高（84.0 ± 17.9 g/m ² vs 76.3 ± 14.8 g/m ²；P =0.001)、更高的相对壁厚 (0.46 ± 0.10 vs 0.40 ± 0.10; P < 0.0001) 和更低的整体纵向应变 (–15.6% ± 2.7% vs –16.6% ± 2.2%; P = 0.006)。结合临床（孕产妇年龄和妊娠早期平均动脉压）和超声心动图特征（左心室质量指数 >75 g/m ²，相对壁厚 >0.42 和 E/e' 比 >7）的预测模型在识别HDP 后持续高血压的女性（曲线下面积：0.85；95% CI：0.79-0.90）。