School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, Australia (A.H., G.M., L.M.R., M.A.B., F.P., A.J.O., G.K.D.).
Departments of Women's and Children's Health (A.H., L.M.R., G.K.D.).
Hypertension. 2024 Apr;81(4):851-860. doi: 10.1161/HYPERTENSIONAHA.123.21890. Epub 2024 Jan 30.
Increased cardiovascular risk following preeclampsia is well established and there are signs of early cardiovascular aging 6 months postpartum. This study assessed whether blood pressure (BP) and other cardiovascular measures are abnormal 2 years postpartum in the same cohort to determine ongoing risk markers.
Six months and 2 years postpartum, BP was measured using sphygmomanometry, 24-hour ambulatory BP monitoring, and noninvasive central BP. Anthropometric measures, blood, and urine biochemistry were performed. Cross-sectional comparisons between preeclampsia and normotensive pregnancy (NP) groups and longitudinal comparisons within each group were made at 6 months and 2 years.
Two years postpartum, 129 NP, and 52 preeclampsia women were studied who also had 6 months measures. At both time points, preeclampsia group had significantly higher BP (office BP 2 years, 112±12/72±8 versus 104±9/67±7 mm Hg NP; [<0.001]; mean ambulatory BP monitoring 116±9/73±8 versus 106±8/67±6 mm Hg NP; [<0.001]). No significant BP changes noted 6 months to 2 years within either group. Office BP thresholds of 140 mm Hg systolic and 90 mm Hg diastolic classified 2% preeclampsia and 0% NP at 2 years. American Heart Association 2017 criteria (above normal, >120/80 mm Hg) classified 25% versus 8% (<0.002), as did our reference range threshold of 122/79 mm Hg. American Heart Association criteria classified 60% post-preeclampsia versus 16% after NP with above-normal ambulatory BP monitoring (<0.001). Other cardiovascular risk markers more common 2 years post-preeclampsia included higher body mass index (median 26.6 versus 23.1, =0.003) and insulin resistance.
After preeclampsia, women have significantly higher BP 6 months and 2 years postpartum, and have higher body mass index and insulin-resistance scores, increasing their future cardiovascular risk. Regular cardiovascular risk screening should be implemented for all who have experienced preeclampsia.
子痫前期后心血管风险增加已得到充分证实，并且产后 6 个月时已有心血管早期衰老的迹象。本研究评估了同一队列中产后 2 年时血压（BP）和其他心血管测量值是否异常，以确定持续存在的风险标志物。
产后 6 个月和 2 年时，使用血压计、24 小时动态血压监测和无创中心血压监测测量 BP，进行人体测量、血液和尿液生化检查。在子痫前期组和正常血压妊娠（NP）组之间进行横断面比较，并在每个组内进行纵向比较。
产后 2 年时，对 129 名 NP 组和 52 名子痫前期组的妇女进行了研究，这些妇女也有 6 个月时的测量数据。在这两个时间点，子痫前期组的 BP 均显著升高（办公室 BP 2 年时为 112±12/72±8 与 NP 组的 104±9/67±7 mm Hg；<0.001；平均动态血压监测 116±9/73±8 与 NP 组的 106±8/67±6 mm Hg；<0.001）。两组内 6 个月到 2 年之间没有观察到 BP 变化。办公室 BP 收缩压阈值为 140 mm Hg，舒张压阈值为 90 mm Hg，在 2 年时分别将 2%的子痫前期和 0%的 NP 归类为异常。美国心脏协会 2017 年标准（高于正常值，>120/80 mm Hg）将 25%的子痫前期和 8%的 NP 归类为异常（<0.002），我们的参考范围阈值 122/79 mm Hg 也是如此。美国心脏协会标准将 60%的子痫前期后与 16%的 NP 后归类为异常，其特征为动态 BP 监测值高于正常值（<0.001）。子痫前期后更常见的其他心血管风险标志物包括更高的体重指数（中位数 26.6 与 23.1，=0.003）和胰岛素抵抗。
子痫前期后，女性产后 6 个月和 2 年时的 BP 明显升高，体重指数和胰岛素抵抗评分更高，增加了未来的心血管风险。所有经历过子痫前期的患者都应定期进行心血管风险筛查。
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