Cardiovascular phenotype in women 1-3 years after hypertensive pregnancy disorders: impact of sex-independent and pregnancy-specific risk factors

OBJECTIVES: The underlying mechanisms for adversely altered cardiovascular phenotype after hypertensive disorders of pregnancy (HDP) remain poorly understood. We aimed to explore the impact of sex-independent cardiovascular disease (CVD) risk factors on associations between HDP and postpartum echocardiographic findings. STUDY DESIGN: Echocardiography was conducted in 100 women 1-3 years after HDP (n = 65) and normotensive pregnancies according to a standard protocol (n = 35). MAIN OUTCOME MEASURES: Associations between previous HDP and echocardiographic measurements were explored by uni- and multivariate regression analyses. We adjusted for age, body mass index, mean arterial blood pressure and family history of CVD. P-value < 0.05 was considered statistically significant. RESULTS: Women after HDP displayed more adverse cardiometabolic profiles, including more frequent Stage 2 hypertension and less frequent normal blood pressure compared to controls (18 % vs 3 % and 46 % vs 83 %, both p < 0.05). The HDP group had more adverse echocardiographic profiles compared to controls. In univariate regression analyses, HDP was associated with Total Vascular Resistance and Septal Wall diameter. After adjustments for sex-independent cardiovascular risk factors, HDP was significantly associated with Septal Wall diameter in diastole and Relative Wall thickness. CONCLUSIONS: Associations between previous HDP and postpartum echocardiographic findings remained significant after adjustment, but were mostly explained by sex-independent CVD risk factors. Women with previous HDP also displayed more adverse cardiometabolic profiles, including higher hypertension rates. Our findings highlight the need for intensified postpartum CVD prevention in women after HDP. In this cohort, echocardiography provided limited additional information beyond well-known risk factors in the evaluation of CVD risk in asymptomatic women with previous HDP.