Pregnancy-induced hypertension tied to increased risk of heart failure: JACC

The study, published in JACC: Heart Failure, revealed that the HF rate in women with pregnancy-induced hypertension was greater versus normotensive women (HR, 1.8). The risk for nonischemic (NICM) and ischemic cardiomyopathy (ICM) was increased with preg-HTN, and these risks were highest in the first six years after pregnancy and persisted after that.

Adverse pregnancy outcomes are reported to be associated with an increased risk of cardiovascular disease (CVD); there is a lack of studies on timing and subtypes of heart failure after a hypertensive pregnancy. To address this knowledge gap, Ängla Mantel, Karolinska Institute, Stockholm, Sweden, and colleagues aimed to evaluate the association between pregnancy-induced hypertensive disorder and risk of heart failure, according to nonischemic and ischemic subtypes and the impact of disease characteristics and the timing of heart failure risks.

The researchers designed a population-based matched cohort study including all primiparous women without a history of CVD from the Swedish Medical Birth Register between 1988 and 2019. Seventy-nine thousand three hundred thirty-four women with a pregnancy-induced hypertensive disorder were matched with 396,531 women with normotensive pregnancies. All women were followed up for incident HF, classified as nonischemic or ischemic, through linkage with health care registers.

Heart failure diagnosis before pregnancy was more common in women with preg-HTN (odds ratio, 1.73). Patients with preg-HTN were more likely to have diabetes pre-pregnancy, be obese, and be more likely to give birth to twins.

The study led to the following findings:

• During a median follow-up of 13 years, rates of all heart failure subtypes were more common among women with pregnancy-induced hypertensive disorder.
• Compared with women with normotensive pregnancies, adjusted HRs (aHRs) were as follows: heart failure overall, aHR: 1.70; ischemic heart failure, aHR: 2.28; and nonischemic heart failure, aHR: 1.60.
• Disease characteristics indicating severe hypertensive disorder were associated with higher heart failure rates, highest within the first six years after the hypertensive pregnancy but remained significantly increased afterwards.

More severe phenotypes of pregnancy-induced hypertension were associated with a greater risk for subsequent heart failure. "Disease characteristics indicating more severe forms of pregnancy-induced hypertensive disorder amplify the heart failure risks," the authors wrote.

"Our findings suggest that women with preg-HTN constitute a high-risk group and should be followed more closely for HF development," they concluded. However, the researchers add that given the study's retrospective nature, the association can be established, but there is no causation.

Reference:

Pregnancy-Induced Hypertensive Disorder and Risks of Future Ischemic and Nonischemic Heart Failure. JACC Heart Fail 2023; May 10:[Epub ahead of print].