Hypertensive disorders of pregnancy and subsequent cardiovascular disease

current national and international guidelines and the need for future research

David T. Gamble, Bolanle Brikinns, Phyo Kyaw Myint, Sohinee Bhattacharya (Corresponding Author)

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Abstract

Background:

It is well established that hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disease (CVD) in later life. National and International guidelines recognize this but due to a lack of research in this area few details are provided on how best to risk stratify or when and how to monitor these women.

Objectives:

This article aims to summarise current guidelines in this area in order to raise awareness of need for further research in this important clinical area.

Search strategy:

A review of the published literature was carried out in August 2018 using the databases EMBASE and Medline and the websites of professional societies were searched manually using the search terms ‘pre-eclampsia’, ‘hypertensive disorders of pregnancy’, ‘management’, ‘guidelines’, ‘long term follow up’ and ‘cardiovascular risk’. Guidelines published in English were included and articles that provided guidance on follow up post-partum of women with HDP.

Main results:

The search identified 360 records. Of these, 16 guidelines mentioned the follow up of women with HDP; their reported years ranges from 2010 to 2018. Only 8 (50%) provided some level of recommendation for follow up beyond the immediate post-partum period. These recognised the future risk of CVD to women from HDP and provide detailed recommendations for the management of these conditions during pregnancy and in the immediate post-partum period. Guidelines recommended that women and primary care clinicians are made aware of this risk and some suggest yearly BP monitoring, and at least 5 yearly monitoring of renal functions, urinalysis and lipid profile testing alongside lifestyle modifications and control of CVD risk factors. Guidelines used a combination of meta analysis, individual cohort studies and expert opinions to inform their recommendations.

Conclusions:

There is a need for future studies of women with a history of HDP to define their trajectory for the development of CVD and candidate biomarkers in order to develop screening, risk stratification, and preventive measures to reduce the significant CV burden associated with HDP in women.
Original languageEnglish
Article number55
Number of pages11
JournalFrontiers in cardiovascular medicine
Volume6
Early online date9 May 2019
DOIs
Publication statusPublished - 17 May 2019

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Cardiovascular Diseases
Guidelines
Pregnancy
Urinalysis
Expert Testimony
Pre-Eclampsia
Research
Meta-Analysis
Life Style
Primary Health Care
Cohort Studies
Biomarkers
Databases
Kidney
Lipids

Keywords

  • pre-eclampsia
  • hypertensive disorder of pregnancy
  • guidelines
  • cardiovascular disease
  • cardiovascular disease in women

Cite this

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title = "Hypertensive disorders of pregnancy and subsequent cardiovascular disease: current national and international guidelines and the need for future research",
abstract = "Background:It is well established that hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disease (CVD) in later life. National and International guidelines recognize this but due to a lack of research in this area few details are provided on how best to risk stratify or when and how to monitor these women.Objectives:This article aims to summarise current guidelines in this area in order to raise awareness of need for further research in this important clinical area. Search strategy:A review of the published literature was carried out in August 2018 using the databases EMBASE and Medline and the websites of professional societies were searched manually using the search terms ‘pre-eclampsia’, ‘hypertensive disorders of pregnancy’, ‘management’, ‘guidelines’, ‘long term follow up’ and ‘cardiovascular risk’. Guidelines published in English were included and articles that provided guidance on follow up post-partum of women with HDP. Main results: The search identified 360 records. Of these, 16 guidelines mentioned the follow up of women with HDP; their reported years ranges from 2010 to 2018. Only 8 (50{\%}) provided some level of recommendation for follow up beyond the immediate post-partum period. These recognised the future risk of CVD to women from HDP and provide detailed recommendations for the management of these conditions during pregnancy and in the immediate post-partum period. Guidelines recommended that women and primary care clinicians are made aware of this risk and some suggest yearly BP monitoring, and at least 5 yearly monitoring of renal functions, urinalysis and lipid profile testing alongside lifestyle modifications and control of CVD risk factors. Guidelines used a combination of meta analysis, individual cohort studies and expert opinions to inform their recommendations.Conclusions:There is a need for future studies of women with a history of HDP to define their trajectory for the development of CVD and candidate biomarkers in order to develop screening, risk stratification, and preventive measures to reduce the significant CV burden associated with HDP in women.",
keywords = "pre-eclampsia, hypertensive disorder of pregnancy, guidelines, cardiovascular disease, cardiovascular disease in women",
author = "Gamble, {David T.} and Bolanle Brikinns and Myint, {Phyo Kyaw} and Sohinee Bhattacharya",
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language = "English",
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journal = "Frontiers in cardiovascular medicine",
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T1 - Hypertensive disorders of pregnancy and subsequent cardiovascular disease

T2 - current national and international guidelines and the need for future research

AU - Gamble, David T.

AU - Brikinns, Bolanle

AU - Myint, Phyo Kyaw

AU - Bhattacharya, Sohinee

PY - 2019/5/17

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N2 - Background:It is well established that hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disease (CVD) in later life. National and International guidelines recognize this but due to a lack of research in this area few details are provided on how best to risk stratify or when and how to monitor these women.Objectives:This article aims to summarise current guidelines in this area in order to raise awareness of need for further research in this important clinical area. Search strategy:A review of the published literature was carried out in August 2018 using the databases EMBASE and Medline and the websites of professional societies were searched manually using the search terms ‘pre-eclampsia’, ‘hypertensive disorders of pregnancy’, ‘management’, ‘guidelines’, ‘long term follow up’ and ‘cardiovascular risk’. Guidelines published in English were included and articles that provided guidance on follow up post-partum of women with HDP. Main results: The search identified 360 records. Of these, 16 guidelines mentioned the follow up of women with HDP; their reported years ranges from 2010 to 2018. Only 8 (50%) provided some level of recommendation for follow up beyond the immediate post-partum period. These recognised the future risk of CVD to women from HDP and provide detailed recommendations for the management of these conditions during pregnancy and in the immediate post-partum period. Guidelines recommended that women and primary care clinicians are made aware of this risk and some suggest yearly BP monitoring, and at least 5 yearly monitoring of renal functions, urinalysis and lipid profile testing alongside lifestyle modifications and control of CVD risk factors. Guidelines used a combination of meta analysis, individual cohort studies and expert opinions to inform their recommendations.Conclusions:There is a need for future studies of women with a history of HDP to define their trajectory for the development of CVD and candidate biomarkers in order to develop screening, risk stratification, and preventive measures to reduce the significant CV burden associated with HDP in women.

AB - Background:It is well established that hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disease (CVD) in later life. National and International guidelines recognize this but due to a lack of research in this area few details are provided on how best to risk stratify or when and how to monitor these women.Objectives:This article aims to summarise current guidelines in this area in order to raise awareness of need for further research in this important clinical area. Search strategy:A review of the published literature was carried out in August 2018 using the databases EMBASE and Medline and the websites of professional societies were searched manually using the search terms ‘pre-eclampsia’, ‘hypertensive disorders of pregnancy’, ‘management’, ‘guidelines’, ‘long term follow up’ and ‘cardiovascular risk’. Guidelines published in English were included and articles that provided guidance on follow up post-partum of women with HDP. Main results: The search identified 360 records. Of these, 16 guidelines mentioned the follow up of women with HDP; their reported years ranges from 2010 to 2018. Only 8 (50%) provided some level of recommendation for follow up beyond the immediate post-partum period. These recognised the future risk of CVD to women from HDP and provide detailed recommendations for the management of these conditions during pregnancy and in the immediate post-partum period. Guidelines recommended that women and primary care clinicians are made aware of this risk and some suggest yearly BP monitoring, and at least 5 yearly monitoring of renal functions, urinalysis and lipid profile testing alongside lifestyle modifications and control of CVD risk factors. Guidelines used a combination of meta analysis, individual cohort studies and expert opinions to inform their recommendations.Conclusions:There is a need for future studies of women with a history of HDP to define their trajectory for the development of CVD and candidate biomarkers in order to develop screening, risk stratification, and preventive measures to reduce the significant CV burden associated with HDP in women.

KW - pre-eclampsia

KW - hypertensive disorder of pregnancy

KW - guidelines

KW - cardiovascular disease

KW - cardiovascular disease in women

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VL - 6

JO - Frontiers in cardiovascular medicine

JF - Frontiers in cardiovascular medicine

SN - 2297-055X

M1 - 55

ER -