Hypertensive Women Attending Cardiac Clinic (original) (raw)
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Annals of African …, 2008
Background: Patients with pre-eclampsia and eclampsia constitute a special high risk group for future hypertension. They require a long term follow up to be able to detect and treat emerging hypertension early enough to prevent complications. Unfortunately, this is not so. This study was undertaken to find out the incidence of history of pre-eclamptic toxaemia (PET) in our female hypertensive patients attending cardiac clinic and to also determine the incidence of complications of hypertension in those with previous history of PET. Methods: Fifty consecutive female hypertensive patients seen in cardiac clinic were recruited. Detailed history including full obstetric and family history was taken. A full clinical examination was done including blood pressure and a search for complications of hypertension. Findings were then analyzed and various frequencies determined. Results: Forty-nine patients were studied. The mean age was 47.29 ± 11.46 years. The mean SBP, DBP and MAP were 143.18 ± 25.05, 90.49 ± 14.19 and 108.12 ± 16.71mmHg respectively. Between the last child birth and the time of established hypertension in those who had PET ranged from 3-25 years. Sixteen, (32.7%) of the 49 patients had history of PET and 7(43.75%) of these 16 patients had complications of hypertension. Conclusion: The incidence of history of PET in our female hypertensive patients attending cardiac clinic is significant (32.7%). Also the 43.8% incidence of complications of hypertension seen in those patients with history of PET in this study is high. PET patients, therefore, constitute a special risk group for future hypertension. Therefore collaboration between the Obstetricians and the Cardiologists is important for patients with PET and eclampsia.
The link between hypertension and preeclampsia/eclampsia-life-long cardiovascular risk for women
Vessel Plus
Cardiovascular diseases remain the main cause of death and morbidity in women. Despite the active preventive measures and the reduction in the total number of morbidity and mortality rates, the rate of cardiovascular morbidity remains high in the population, moreover cardiovascular morbidity is increased in women of 35-54 years. Cardiovascular morbidity has several unique characteristics for women; pregnancy, gestational hypertension, preeclampsia/eclampsia are genderspecific risk-factors for further cardiovascular morbidity in women, it's possible to detect these risk-factors in younger age groups and start prevention as early as possible. Arterial hypertension, which is characterized by genetic polymorphism, is an important and a powerful risk factor for development of both acute and chronic cardiovascular diseases; association of arterial hypertension with different metabolic disorders suah as metabolic syndrome, diabetes seems particularly dangerous in pregnancy in terms of peri-pregnancy and lifelong morbidity. Preeclampsia shares some common features with atherogenesis and metabolic changes and atherogenesis and metabolic changes, so presence of hypertension during pregnancy increases the risk of cardiovascular diseases and diabetes later in the life. Is pregnancy revealing or predisposing factor of development cardiovascular diseases is not still clear and to answer these questions more and more studies are required.
Preeclampsia and cardiovascular risk: general characteristics, counseling and follow-up
Journal of nephrology
The pathophysiological mechanisms underlying preeclampsia, a serious complication of pregnancy, are largely unknown. Since, on the other hand, the various risk factors are known, primary and secondary prevention with pre-and inter-pregnancy counseling should be undertaken, and a follow-up should be conducted to evaluate any long-term organic complications. There is evidence in the literature that women with preeclampsia are particularly predisposed to developing cardiovascular diseases, especially ischemia, and it is justifiably believed that preeclampsia and atherosclerosis share the same risk factors. However, further understanding is required concerning the risk of long-term dysfunctions in other organs also involved in the course of preeclampsia: the kidneys, liver and brain. Preeclampsia is, moreover, a complex multispecialist entity, and the internist and/or the intensivist can be important allies along with the obstetrician in the management of this condition.
Long-Term Risk to Develop Hypertension in Women With Former Preeclampsia: A Longitudinal Pilot Study
Reproductive Sciences, 2014
Introduction: Women with former preeclampsia (exPE) develop chronic hypertension 4 times more often than healthy parous controls. Women, destined to develop remote chronic hypertension, had increased left ventricular mass index (LVMI) and diastolic blood pressure (BP) prior to the onset of hypertension as compared to those remaining normotensive. However, longitudinal data on the progress of this increased LVMI in women destined to develop hypertension are lacking. Methods: We included 20 women with exPE and 8 parous controls. At both 1-and 14-year postpartum (pp), we performed cardiac ultrasound and determined circulating levels of the metabolic syndrome variables. Of 14-year pp, 7 (35%) former patients had developed chronic hypertension. We compared these 7 former patients with both the 13 former patients who remained normotensive and the 8 parous controls using the Mann-Whitney U test and Kruskal-Wallis analysis. Results: Women with hypertensive exPE differed from their normotensive counterparts by a higher incidence of early-onset preeclampsia (PE) in their index pregnancy and a higher rate of recurrence in next pregnancies. At 1-year pp, they also had high/normal BP and higher fasting insulin levels. At 14 years pp, the relative left ventricular wall thickness was higher, and the E/A ratio was lower, in the hypertensive group relative to those remaining normotensive. Conclusion: Women with exPE are at increased risk of developing chronic hypertension, when (1) the PE in the index pregnancy had an early-onset and/or recurred in next pregnancies and (2) the 1-year pp. Blood pressure was high normal. We also noticed that at 14 years pp, the hypertensive group showed signs of concentric left ventricular remodeling along with a decreased E/A ratio.
Pre-Eclampsia and Future Cardiovascular Risk Among Women
Journal of the American College of Cardiology, 2014
Cardiovascular disease continues to be the leading cause of death in the western world. Due to advancements in diagnosis, prevention, and treatment, cardiovascular mortality has fallen in recent years. Previous studies have evaluated the impact of traditional risk factors such as hypercholesterolemia and smoking. However, limited studies have been conducted to evaluate sex discrepancies among patients with cardiovascular disease. Pre-eclampsia is a multisystem placentally mediated disease, which usually arises after 32 weeks of gestation and classically presents with hypertension and proteinuria. Pre-eclampsia affects 2% to 8% of all pregnancies worldwide and is often complicated by fetal growth restriction. Women with a history of pre-eclampsia are at increased risk of future cardiovascular complications. Therefore, this topic is of significance to the cardiovascular health of over 300 million women worldwide. The goal of this review is to determine the association of pre-eclampsia and future cardiovascular risk and to explore the potential management options for these high-risk women.
Pre-Eclampsia-Pregnancy Induced Hypertension; Threats and Consequences
INTERNATIONAL JOURNAL OF ENDORSING HEALTH SCIENCE RESEARCH (IJEHSR), 2014
Pre-eclampsia is the elevated blood pressure and excess protein in the urine after 20 weeks of pregnancy in a woman who previously had normal blood pressure, a major cause of preterm birth and an early marker for future cardiovascular and metabolic diseases. The objective of study is to identify the level of awareness regarding pre-eclampsia (pregnancy induced hypertension or gestational hypertension) and its relation with increasing maternal and fetal mortality rate. The questionnaire based survey was conducted including both close & open ended questions and compared with the retrospective data among 160 respondents, in which our target was to investigate women of varying socioeconomic status & the duration of our research is almost 20 days. Statistically we found an overall poor awareness of pre-eclampsia with 26% of women surveyed having heard of it and remaining 74% were unknown to pre-eclampsia, 39% faced pre-eclampsia with its severe consequences and fetal mortality rate data showed 42% deaths stating pre-eclampsia as the major cause of it, in addition to that higher rate of maternal death i.e. 57% occurs due to pre-eclampsia subsiding other reasons as key reasons of maternal mortality. Hence it is concluded that Pre-eclampsia is a disorder of pregnancy with unknown etiology so awareness level is too low to decrease its incident & this lack of awareness translates to worse health outcomes proving pre-eclampsia as a major cause of maternal and fetal mortality and its lack of awareness increasing this risk day by day and making it a hidden threat to pregnancy.
Acta Obstetricia Et Gynecologica Scandinavica, 2010
Objective. To determine the risk of preeclampsia in a population with respect to maternal and sister histories of chronic hypertension, preeclampsia and eclampsia. Design. A case-control study of severe preeclampsia. Setting. Maternity hospital in Natal, Brazil. Participants. A total of 412 subjects were enrolled, 148 cases and 264 controls. Main outcome measures. Personal and familial histories of hypertensive disorders. Odds ratio estimates of preeclampsia with respect to family history of hypertensive diseases. Results. Women with a history of hypertensive disorders were more frequent in the case group (p = 0.001). Women whose mothers had a history of hypertension (p = 0.003), preeclampsia (p = 0.007) or eclampsia (p = 0.038) were at increased risk of severe preeclampsia. The risk of preeclampsia was greater when the woman had a sister with a history of hypertension (OR 2.60, 95% CI 1.60-4.21, p < 0.001), preeclampsia (OR 2.33, 95% CI 1.58-3.45, p < 0.001), or eclampsia (OR 2.57, 95% CI 1.28-5.16, p = 0.008). The risk of preeclampsia was also higher for women who had both a mother and sister with a history of hypertension (OR 3.65, 95% CI 1.65-8.09, p = 0.001). Conclusions. A family history of hypertensive disorders increased the risk of eclampsia and hemolysis elevated liver enzymes and low platelet (HELLP) syndrome in a Brazilian population.
Pregnancy Hypertension, 2019
To estimate the incidence of hypertension and the trend of systolic and diastolic blood pressure changes and relating factors influencing women with and without prior preeclampsia (PE). Study design: This prospective population based study included a total of 3022 eligible women (355 with PE and 2667 non-PE) recruited from participants of the Tehran Lipid and Glucose Study (TLGS) who were assessed for progression to subsequent hypertension over 15-year follow up. Pooled logistic regression model was utilized to estimate odds ratio (OR) of hypertension. The generalized estimating equation (GEE) was used to evaluate the trend of changes in hypertension parameters over time. Results: At the end of follow-ups, 109 women (30.7%) in the PE group and 575 (21.5%) in the non-PE group had hypertension. The total cumulative incident rate of hypertension was 34/1000 person-years for PE groups and 22/1000 person years for non-PE groups (P < 0.001). Pooled logistic regression analysis showed that compared to non-PE women, OR of hypertension progression in women with PE was 3.70 after adjustment for age, body mass index (BMI), parity, triglycerides (TG) and high-density lipoprotein (HDL-C) (P-value < 0.001). Based on GEE analysis, mean changes of systolic and diastolic blood pressure in PE women increased by 4.66 and 2.55 mmHg, respectively, compared to the non-PE group, after adjustment for age, and BMI at baseline (P < 0.001), although the interaction term (follow-up year × PE) was not statistically significant. Conclusion: This study demonstrated increased chances of developing hypertension among women with prior PE, particularly in those who develop additional risk factors in their later life, compared to the non-PE women. While the trajectory of blood pressure change over time is similar between women with and without preeclampsia, women with a history of preeclampsia consistently have higher levels of blood pressure.