(463) Prepregnancy hypertension and the risk of twelve cardiovascular diseases: The role of adverse pregnancy outcomes

The study consisted of 1,784,247 birth records in 1.2 million women; 12,698 (0.71%) records had prepregnancy hypertension. During 20-year follow-up, 16,499 women had incident CVD; two-thirds (66%) occurred in women under 40 years. Prepregnancy hypertension (vs no prepregnancy hypertension) was associated with a 2-fold higher risk of any CVD event [aHR=2.22 (95% CI: 2.03‒2.42)]. When women were further categorized according to history of APO, risk was highest in those with prepregnancy hypertension and a history of APO for each of the 12 CVD events ranging from aHR=9.65 (95%CI, 5.96‒15.6) for heart failure to 2.66 (95%CI, 2.17‒3.26)] for stable angina compared to normotensive women without APOs. Women with prepregnancy hypertension without APOs also had elevated risk compared to normotensive without APOs: aHRs ranged from 5.25 (95%CI, 3.47‒7.94) for subarachnoid hemorrhage to 1.26 (95%CI, 0.59‒2.67) for peripheral arterial disease. In women who experienced APOs, but without prepregnancy hypertension, the risk of CVD ranged from 3.27 (95%CI, 2.48‒4.31) for intracerebral hemorrhage to 1.33 (95%CI, 1.26‒1.41) for stable angina. Risk of CVD was further elevated in women who had superimposed pre-eclampsia.

Conclusion: Women with prepregnancy hypertension had a higher risk of subsequent CVD, and the risk was further elevated with a history of APO. Women who experienced APO may have more severe underlying hypertension; appropriate management of hypertension during pregnancy could lower the risk of APOs and future CVD. Including history of APO in CVD screening might lower subsequent CVD burden.