Abstract 20509: Progression From Hypertensive Disorders of Pregnancy to Chronic Hypertension: Obesity Appears Especially Detrimental
Introduction: Hypertensive disorders of pregnancy (HDP), including preeclampsia and gestational hypertension, complicate 5-10 % of all pregnancies. Affected women have a higher risk of chronic hypertension and cardiovascular disease later in life. However, the role of lifestyle in the progression to chronic hypertension in this high risk group is unknown relative to women without a history of HDP.
Hypothesis: We assessed the hypothesis that BMI, diet, physical activity, and Na/K intake modify the association between history of HDP and later chronic hypertension.
Methods: We followed parous women (N=53,667, 35-55 yrs) for self-reported chronic hypertension outside of pregnancy from 1991 to 2011 in the questionnaire-based prospective cohort Nurses’ Health Study II. We used multivariable Cox proportional hazards models to study the association between history of HDP and chronic hypertension by BMI, physical activity, adherence to the Dietary Approaches to Stop Hypertension (DASH) diet, and Na/K intake. To assess public health relevance, we evaluated each lifestyle factor as an effect modifier on the additive scale by calculating the Relative Excess Risk due to Interaction (RERI).
Results: In general, women with and without a history of HDP demonstrated similar increase in chronic hypertension risk with less optimal lifestyle. However, the increased risk of chronic hypertension observed with higher BMI was substantially greater among women with prior HDP than among those without HDP (RERI global p≤0.001). In women with a higher than normal BMI and prior HDP, 22 to 31% of their risk of chronic hypertension was attributed to the presence of both of these factors. For example, among women 35-44 yrs, those with obesity class I (BMI 30-34.9) and a history of HDP had a hazard ratio of 9.7 (95% confidence interval: 7.7 to 12.2) for chronic hypertension compared to women with low normal weight (BMI 18.5-22.4) and no prior HDP. Thirty percent (95% CI: 8 to 51 %) of their absolute risk of chronic hypertension was attributed to the presence of both risk factors.
Conclusions: Whereas a less optimal lifestyle generally increases the risk of chronic hypertension, this study suggests that overweight and obesity are especially detrimental for women with a history of HDP.
Author Disclosures: S. Timpka: None. J.J. Stuart: None. L.J. Tanz: None. E.B. Rimm: None. P.W. Franks: None. J.W. Rich-Edwards: None.
- © 2016 by American Heart Association, Inc.