Subject(s)
Blood Pressure , Hypertension, Pregnancy-Induced/epidemiology , Hypertension/epidemiology , Hypertrophy, Left Ventricular/epidemiology , Ventricular Dysfunction, Left/epidemiology , Aged , Blood Pressure Monitoring, Ambulatory , Echocardiography , Female , Humans , Hypertension/diagnosis , Hypertension/physiopathology , Hypertension, Pregnancy-Induced/diagnosis , Hypertension, Pregnancy-Induced/physiopathology , Hypertrophy, Left Ventricular/diagnosis , Hypertrophy, Left Ventricular/physiopathology , Middle Aged , Pregnancy , Prevalence , Prognosis , Risk Assessment , Risk Factors , Sweden/epidemiology , Time Factors , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/physiopathology , Ventricular Function, LeftABSTRACT
INTRODUCTION: Epidemiological data indicate an increased cardiovascular risk in women with previous hypertensive pregnancies. There are few clinical investigations regarding the mechanisms that could mediate this increased risk. OBJECTIVES: The aim of the present study was to clarify if any deterioration in the cardiovascular, metabolic or neuroendocrine status is present in women 40 years after pregnancies complicated by hypertension. METHODS: Three hundred and nineteen women were invited to take part in a follow up investigation regarding cardiovascular regulation. One hundred and five women accepted to participate - 50 with previously hypertensive pregnancies (HTP) and 55 with normotensive pregnancies (NTP). Office and ambulatory blood pressure levels, central blood pressure and pulse wave velocity, echocardiographic measurements (RWT, LVMI, LA, LA-RA, diastolic function, strain) and P-glucose, HbA1c, S-leptin, S-hsCRP, P-renin, P-Noradrenaline and NT-proBNP were examined. Women who choose not to participate (n=214) were followed up with a questionnaire regarding their previous pregnancies and present cardiovascular health. RESULTS: The investigations did not reveal differences in any examined variables regarding blood pressure, echocardiographic parameters or blood analysis for metabolic and neurohumoral balance. Twenty-five individuals were diagnosed with hypertension in the HTP group (mean BP 145/86mmHg) and 17 subjects in the NTP group (mean BP 145/87mmHg). The questionnaire was answered by 79% of the participants and revealed that these women had an impaired cardiovascular health compared to the group investigated. CONCLUSION: Blood pressure, metabolic and neuroendocrine parameters are not permanently worsened in all women with previous hypertensive pregnancies. There exist disparities within the group of women with previous hypertensive pregnancies and there are women without obvious cardiovascular or metabolic dysfunction 40 years after the hypertensive manifestation during pregnancy.
ABSTRACT
The aim of this retrospective study in primary health care was to study gender differences in blood pressure levels in response to treatment of new onset hypertension. Gender difference in blood pressure control and pharmacological treatment was also recorded. A total of 334 women and 332 men aged ≥50 years and <80 years at baseline, with blood pressure ≥140 mm Hg systolic and/or ≥90 mm Hg were included. Men were younger, had a higher frequency of type II diabetes mellitus and a higher body mass index compared with women at baseline. There was no difference between women and men in systolic blood pressure (SBP) before or after treatment. Women however had a lower diastolic blood pressure (DBP) before and after intervention and as a result a higher pulse pressure (PP). Approximately 50% of the patients reached target blood pressure (≤140/90 mm Hg) in both women and men. Beta blocker was the most commonly used antihypertensive treatment in both genders, whereas diuretics were predominately used in women. In conclusion; women and men reached target blood pressure to the same extent but with different antihypertensive treatment strategies. Differences at baseline in risk factor pattern may explain the finding.
