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Maternal–Fetal Medicine
Hypertension in Pregnancy and Future Cardiovascular Disease
a report by
Stacey Ann Dixon Grandison, MBBS
1
and Vesna D Garovic, MD
2
1. Research Fellow; 2. Associate Professor, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine
Gender-specific factors that may influence the onset of cardiovascular early 1970s.
6,7
In their frequently cited study, they reported that
disease (CVD), its clinical course, the efficacy of therapy, and prognosis have primiparous pre-eclamptic women were not different from controls in
long been ignored. Renewed interest in female-specific conditions occurred terms of the development of hypertension, mortality secondary to CVD,
as a result of the CVD pandemic in women, when it became apparent that or overall mortality. This study had several serious limitations, most
the decline in cardiovascular mortality in men was not associated with a notably small sample sizes and a suboptimal control group, which
similar rate of decline in women.
1
Clinical studies exploring gender-based consisted of women from previously published epidemiological studies,
disparities have indicated that women have been both underevaluated for conceivably including some women with hypertensive pregnancy
CVD and undertreated for modifiable CVD risk factors.
2,3
On the research disorders in addition to those with normotensive pregnancies. Despite
side, it has become apparent that the relative significance of known CVD risk these limitations, the results of this study served as a basis for the widely
accepted view that hypertensive diseases of pregnancy are limited to the
affected pregnancy and have few, if any, long-term maternal effects.
Hypertension in pregnancy includes a
spectrum of conditions, including
The steadily increasing rates of CVD in women have renewed interest in
the field as part of an attempt to study and characterize possible
pre-eclampsia–eclampsia, pre-eclampsia contributing female-gender-specific factors. In 1986, Sibai et al.
8
superimposed on chronic hypertension,
reported a significantly higher incidence of hypertension in patients with
history of pre-eclampsia or eclampsia during their first pregnancies
chronic hypertension, and gestational compared with women who had had normotensive first pregnancies.
hypertension.
This association was further supported by both prospective
9
and
retrospective studies.
10–12
In our recent study, we reported that women
with history of pre-eclampsia had a higher prevalence of future
factors may be gender-specific.
4
In addition, research efforts have focused on hypertension (48.5% hypertensive at an average of 54 years of age) than
conditions unique to women, such as contraception, menopause and
hormone-replacement therapy, and hypertension in pregnancy.
Stacey Ann Dixon Grandison, MBBS, is a Research Fellow at
Mayo College of Medicine in Rochester. She works with
It is estimated that about 10% of pregnancies are affected by hypertension Dr Vesna Garovic on the mechanisms of kidney injury in
worldwide. Hypertension in pregnancy includes a spectrum of conditions,
5 pre-eclampsia and the impact of pre-eclampsia on future
cardiovascular health. Ms Grandison completed her medical
including pre-eclampsia–eclampsia, pre-eclampsia superimposed on chronic
training at the University of the West Indies, Mona.
hypertension, chronic hypertension, and gestational hypertension (see Table 1).
Approximately half of all hypertensive pregnancy disorders are due to pre-
eclampsia, a pregnancy-specific multisystem disorder that is clinically
characterized by hypertension and proteinuria that occurs after 20 weeks of
Vesna D Garovic, MD, is an Attending Physician in the Division
gestation. The purpose of this article is to present the evidence-based data that
of Nephrology and Hypertension and an Associate Professor of
Internal Medicine at the Mayo Clinic College of Medicine in
support the associations between hypertension in pregnancy on the one hand
Rochester. She joined the Division of Nephrology and
and future hypertension, coronary heart disease (CHD), and stroke on the
Hypertension at Mayo Clinic in 1999. She has been awarded a
other. In addition, the possible mechanisms that may underlie these
research grant by the National Institute of Child Health and
Human Development (NICHD) to study the mechanisms of
associations will be discussed, along with the guidelines for long-term follow-
kidney injury in pre-eclampsia. Dr Garovic’s clinical research
up and management of these patients.
focuses on the long-term cardiovascular effects of hypertensive
pregnancy disorders. Dr Garovic received her MD from Belgrade Medical School, Serbia, after
which she finished her training in obstetrics and gynecology. She initially moved to Montreal,
Hypertension in Pregnancy and
where she undertook post-graduate training in medical genetics at McGill University, and then
Risk for Hypertension Later in Life
moved to New York, where she finished her residency in internal medicine and fellowship in
While an association between pre-eclampsia and the future development
nephrology at Albert Einstein College of Medicine in the Bronx.
of hypertension and renal disease was first recognized in the 19th E:
garovic.vesna@mayo.edu
century, this association was challenged by Chesley and colleagues in the
© TOUCH BRIEFINGS 2008
45
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