Abstract 2025: Hypertension in Pregnancy is Associated with a Higher Incidence of Cardiovascular Events later in Life
Hypertension complicates 10% of pregnancies, contributing to maternal and fetal morbidity and mortality. We assessed whether hypertension in pregnancy predicts an increased risk for cardiovascular disease later in life. The sample included 4782 women from sibships with ≥2 members diagnosed with essential hypertension prior to age 60 years, who participated in the Family Blood Pressure Program (FBPP) study in 2000 –2005. Subjects were categorized into subgroups with 1) no history of pregnancy lasting more than 6 months (n=718), 2) normotensive pregnancies (n=3421), and 3) at least one hypertensive pregnancy (n=643). The following analyses were performed to assess the effects of hypertension in pregnancy: Cox proportional hazard models to study effects on age of onset for cardiovascular events, and multiple regression models to analyze effects on conventional risk factors for coronary heart disease, while controlling for race, education, smoking, family history and body mass index (BMI). In addition, we studied effects on novel risk factors in a subset of 1755 women within the Genetic Epidemiology Network of Arteriopathy (GENOA) study of the FBPP. Women with hypertensive pregnancies, compared to those with normotensive pregnancies, had a two-fold hazard ratio for stroke (p= 0.003), a 1.5 hazard ratio for coronary heart disease (p= 0.04), and a 1.5 hazard ratio for hypertension after the age of 40 (p<0.0001). In addition, they had a higher urine albumin-creatinine ratio (p=0.001) and higher BMI (p<0.0001). In GENOA, women with hypertensive pregnancies also had higher C-reactive protein and homocysteine levels, both when BMI was added (p=0.03 and p=0.008, respectively) and removed (p=0.0001 and p=0.002, respectively) from the multiple regression models. In models without BMI, pregnancy hypertension was also associated with higher fibrinogen (p<0.0001). No difference in lipoprotein (a) or small dense LDL was observed, both with and without BMI. We conclude that history of hypertension in pregnancy is associated with greater risk of cardiovascular events later in life. This may be due partly to common risk factors that are shared by cardiovascular and hypertensive pregnancy disorders, including obesity, endothelial dysfunction, and inflammation.