Altered cardiac and vascular stiffness in pregnancy after a hypertensive pregnancy

Castleman, James S, Shantsila, Alena ORCID: 0000-0002-0594-8576, Brown, Richard A, Shantsila, Eduard ORCID: 0000-0002-2429-6980 and Lip, Gregory YH ORCID: 0000-0002-7566-1626 (2023) Altered cardiac and vascular stiffness in pregnancy after a hypertensive pregnancy. JOURNAL OF HUMAN HYPERTENSION, 37 (3). pp. 189-196.

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Official URL: http://dx.doi.org/10.1038/s41371-022-00662-4

Abstract

Hypertensive disorders of pregnancy are an important cause of morbidity and mortality, impacting on both maternal and fetal wellbeing. Affected women are at higher risk of future cardiovascular morbidity and mortality. Our study objective was to assess differences in cardiovascular function in pregnant women previously affected by gestational hypertension or preeclampsia. Pregnant women diagnosed with gestational hypertension or preeclampsia in a previous pregnancy were recruited at the start of a subsequent pregnancy and compared to healthy pregnant and non-pregnant controls. All patients underwent pulse wave analysis and echocardiography. Indexes of echocardiography-derived arterial and left ventricular elastance were calculated. In our study women with prior hypertension (n = 25) were more likely to have blood pressure in the 120-139/80-99 mmHg (prehypertension) range. Women with previous hypertension in pregnancy had increased late diastolic transmitral flow velocities (A wave) and increased augmentation index. Women without prior hypertension (n = 50) demonstrated more compliance (reduced EaI and Ees) compared to the non-pregnant controls (n = 40). This adaptation was not seen in pregnancy with prior hypertension, where increased arterial stiffness was observed. In conclusion we have shown increased prevalence of prehypertension and increased arterial stiffness in pregnant women previously affected by gestational hypertensive disease. An increased atrial component to ventricular filling reflects altered diastolic function after hypertensive pregnancy. These women are at increased future cardiovascular risk due to altered cardiac and vascular function and require effective risk mitigation.

Item Type:	Article
Uncontrolled Keywords:	Humans, Hypertension, Pregnancy-Induced, Pre-Eclampsia, Pregnancy, Blood Pressure, Female, Prehypertension, Vascular Stiffness
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences Faculty of Health and Life Sciences > Institute of Population Health
Depositing User:	Symplectic Admin
Date Deposited:	05 Apr 2022 15:31
Last Modified:	22 Mar 2023 07:29
DOI:	10.1038/s41371-022-00662-4
Open Access URL:	https://doi.org/10.1038/s41371-022-00662-4
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3152185