Laura Benschop

Blood Pressure Profile 1 Year After Severe PreeclampsiaNovelty and Significance

Preeclampsia increases the long-term risk of cardiovascular disease, possibly through occurrence of hypertension after delivery, such as masked hypertension, night-time hypertension, and an adverse systolic night-to-day blood pressure (BP) ratio. These types of hypertension are often unnoticed and can only be detected with ambulatory BP monitoring (ABPM). We aimed to determine hypertension prevalence and 24-hour BP pattern with ABPM and office BP measurements in women 1 year after severe preeclampsia. This is a retrospective cohort study. As part of a follow-up program after severe preeclampsia, 200 women underwent ABPM and an office BP measurement 1 year after delivery. We calculated hypertension prevalence (sustained hypertension, masked hypertension, and white-coat hypertension) and systolic night-to-day BP ratio (dipping pattern). Medical files and questionnaires provided information on preexisting hypertension and antihypertensive treatment. One year after delivery, 41.5% of women had hypertension (sustained hypertension, masked hypertension, or white-coat hypertension) with ABPM. Masked hypertension was most common (17.5%), followed by sustained hypertension (14.5%) and white-coat hypertension (9.5%). With sheer office BP measurement, only 24.0% of women would have been diagnosed hypertensive. Forty-six percent of women had a disadvantageous dipping pattern. Hypertension is common 1 year after experiencing severe preeclampsia. Masked hypertension and white-coat hypertension are risk factors for future cardiovascular disease and can only be diagnosed with ABPM. Therefore, ABPM should be offered to all these women at high risk of developing hypertension and possibly future cardiovascular disease.

Prevalence of Subclinical Coronary Artery Disease Assessed by Coronary Computed Tomography Angiography in 45- to 55-Year-Old Women With a History of Preeclampsia

Preeclampsia is associated with an increased risk of coronary artery disease (CAD), although evidence on premature CAD development after preeclampsia is limited.1 A cross-sectional study among 491 postmenopausal women with a mean age of 67 years showed an increased prevalence of coronary artery calcification (CAC) in participants with self-reported high blood pressure during any previous pregnancy in comparison with women without such a history.2 However, the association between hypertensive pregnancy, CAC, and coronary plaque formation has not been reconfirmed in prospective studies, and there are no data on the timeline by which atherosclerosis develops in women with previous preeclampsia. The aim of this study is to compare the prevalence of coronary artery atherosclerosis of asymptomatic women aged 45 to 55 years who have a history of preeclampsia with a population-based reference cohort. The rationale and design of the CREW-IMAGO study (Cardiovascular Risk Profile: Imaging and Gender-Specific Disorders) have been published previously (URL: http://www.trialregister.nl/trialreg/index.asp. Unique identifier: NTR5531).3 Asymptomatic women, aged 45 to 55 years, with a history of preeclampsia 10 to 20 years earlier were included in this multicenter, prospective cohort study. Medical records, including pregnancy characteristics and hospital admission, were available for all women. Outcomes were compared with women of similar age and ethnicity who participated …

Maternal lipid profile 6 years after a gestational hypertensive disorder

BACKGROUND Gestational hypertensive disorders (GHDs), including gestational hypertension and preeclampsia, are associated with an increased risk of cardiovascular disease in later life, possibly through an atherogenic lipid profile. OBJECTIVE The objective of this study is to assess if women with a previous GHD have a more atherogenic lipid profile 6 years after pregnancy compared to women with a previous normotensive pregnancy. METHODS In a population-based prospective cohort study, we included 4933 women during pregnancy, including 302 women with a GHD. Six years after pregnancy, we determined maternal lipid profile (total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, lipoprotein[a], and apolipoprotein B) and glucose levels. RESULTS Women with a previous GHD had a more atherogenic lipid profile 6 years after pregnancy compared to women with a previous normotensive pregnancy. These atherogenic lipid profiles were a result of higher levels of triglycerides, low-density lipoprotein cholesterol, and apolipoprotein B and lower levels of high-density lipoprotein cholesterol. Differences in lipid profile between women with a previous GHD and women with a previous normotensive pregnancy were attenuated after adjustment for prepregnancy body mass index. Between women from both groups, no differences were observed in total cholesterol, lipoprotein[a], and glucose levels. CONCLUSION Women with a previous GHD show a more atherogenic lipid profile 6 years after pregnancy than women with a previous normotensive pregnancy. The increased risk of cardiovascular disease after a GHD might result from an atherogenic lipid profile after pregnancy, primarily driven by prepregnancy body mass index.

Correction to: Gestational hypertensive disorders and retinal microvasculature: the Generation R Study

Author details Department of Obstetrics and Gynecology, Erasmus Medical Center, Wytemaweg 80, PO Box 2040, 3000, CA, Rotterdam, The Netherlands. Department of General Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands. Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands. Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore. Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong.