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Keeping a healthy weight lowers risk of chronic hypertension in women with HDP history

Stephen Padilla
21 Jul 2017

Adherence to a beneficial lifestyle may significantly reduce the risk of chronic hypertension after hypertensive disorders of pregnancy (HDP) such as gestational hypertension and pre-eclampsia, a recent study suggests. Keeping a healthy weight appears to be critical in women with a history of HDP compared with those without such a history.

“A history of HDP is associated with a higher risk of chronic hypertension, and our data suggest that overweight or obesity might be especially detrimental to affected women,” researchers said. “In contrast, we found no evidence that physical activity or dietary quality differ in their importance in preventing chronic hypertension by HDP history.”

In this study, a total of 5,520 women (10 percent) had a history of HDP at baseline, and 13,971 cases of chronic hypertension occurred during 689,988 person-years of follow-up.

The only lifestyle factor consistently associated with a higher risk of chronic hypertension was being overweight or obese. In particular, higher body mass index (BMI) elevated the risk of chronic hypertension associated with HDP history (relative excess risk due to interaction p<0.01 for all age strata). [BMJ 2017;358:j3024]

For instance, in women aged 40 to 49 years with previous HDP and obesity class I (BMI, 30.0 to 34.9), 25 percent (95 percent CI, 12 to 37 percent) of the risk of chronic hypertension was regarded as being caused by a potential effect of obesity that was specific to women with previous HDP.

“[W]omen with both overweight/obesity and history of HDP had a higher than expected risk of chronic hypertension, given the risks observed when these risk factors were considered separately,” researchers said. “Hypertensive pregnancy may be an early warning sign of an adverse cardiometabolic composition, which temporarily manifests under the metabolic stress of pregnancy.” [BMJ 2002;358:157-60]

Furthermore, no clear evidence of effect modification by physical activity, Dietary Approaches to Stop Hypertension (DASH) diet or sodium/potassium intake existed on the association between HDP and chronic hypertension.

“A healthy weight thus seems to be of additional importance in women with a history of HDP,” according to researchers. “Consequently, interventions focused on weight optimization could potentially reduce the risk of chronic hypertension to a greater extent in this group than among other parous women.”

In this prospective cohort study, the authors assessed 54,588 parous women (aged 32 to 59 years) from the Nurses’ Health Study II (1991 to 2013) with data on reproductive history and without previous chronic hypertension, stroke or myocardial infarction.

“This is the first study to comprehensively assess the relative importance of lifestyle factors in the progression to chronic hypertension in women with a history of HDP compared with parous women without such a history,” researchers noted, adding that the primary weakness of this study is the reliance on nurse participants’ self report of HDP exposure.

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