Although almost 30 percent of first...

Although almost 30 percent of first pregnancies are believed to be complicated through hypertension, preeclampsia, or eclampsia, the long-term implications for these mothers are unclear. These hypertensive conditions of pregnancy have been reported to be associated with hypertension later in life, further small size and other limitations of the studies limit the ability of physicians to use these eventuates to counsel patients or identify women at increased risk of significant hypertension. Wilson and colleagues used data about women who delivered in a Scottish city between 1951 and 1970 to clarify the risk of developing hypertension years after having a hypertensive condition of pregnancy.

From the original cohort of 3593 women they identified 1197 who had gestational hypertension and 1199 who had preeclampsia/eclampsia during their first singleton pregnancy. To provide a bridle group, these women were matched by the agency of age and year of delivery with 1197 mothers who had no elevations of vital fluid pressure during pregnancy. Women with chronic hypertension at the time of pregnancy were exclud from the contemplation Community health registers were used to identify all participants still living in the United Kingdom. National data registries provided information about women who had died. Women still living in the region were invited to out and out a health questionnaire and suffer medical examination.

Overall, the average age at delivery was 24 years. Women in the manage group were more likely to be of higher social status than those in the hypertensive clumps Questionnaires were returned from 1312 women and 992 not awayed for medical examination. Women who had hypertension or preeclampsia/eclampsia were significantly more likely than direct subjects to have evidence of later hypertension, plane after adjustment for risk factors for hypertension. The unevens ratio for a physician-confirmed diagnosis of hypertension was 267 in women who had gestational hypertension and 302 in women with pre-eclampsia/eclampsia (see the accompanying table). Similarly, the additionals ratios for taking antihypertensive medication were 201 and 214 respectively.

Women who had hypertensive conditions of pregnancy also had higher unmatcheds ratios for many of the serious adverse issues of hypertension later in life. For pat gestational hypertension had an left over s ratio of 2.23, and preeclampsia/eclampsia had an redundants ratio of 3.39; for angina, additionals ratios were 1.11 and 159 respectively; and for intermittent claudication, 156 for as well-as; not only-but also; not only-but; not alone-but pregnancy conditions. Women in the sum of two units groups were more likely to have been admitted to a hospital for circulatory diseases, especially hypertension. Analysis of the 265 deaths identified in the close attention population revealed that total mortality, shock and cardiovascular mortality were higher in the gestational hypertension and pre-eclampsia/eclampsia women than in the mastery group, and significantly higher for rap in women who had preeclampsia/ eclampsia.

The authors deduce that hypertensive conditions of pregnancy are associated with hypertension later in life and that women with this history have an increased risk of reverse and cardiovascular disease. The magnitude of the risk appears to be at least double that of women who do not have hypertension during pregnancy, nevertheless the risk is even more increased in those who have preeclampsia.

Anne D Walling, MD

Wilson BJ et al. Hypertensive diseases of pregnancy and risk of hypertension and hardship in later life: results from cohort application of mind BMJ April 19, 2003;326:845-9

Editor's Note: Data increasingly indicate that preeclampsia is an arterial, possibly plane an endothelial, disease. While the molecular on a level research can be difficult to understand, it is clear that we are finish to a real understanding of the mechanisms of these conditions. We reliance that more effective treatments will tread close upon As family physicians, we appreciate the cloyed implications of preeclampsia as common manifestation of a complex, familial arterial disease. The open message of this study is to be especially vigilant for cardiovascular disease in women who have any history of hypertension during pregnancy. Perhaps we can advance further. Can we use family history to identify the young woman who is at risk of hypertension unruffled before she becomes pregnant, and assist her to avoid not just a difficult pregnancy, still possibly a premature cardiovascular disease?--A.D.W.

COPYRIGHT 2003 American Academy of Family Physicians

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