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Does a history of hypertensive disorders of pregnancy help predict future essential hypertension? Findings from a prospective pregnancy cohort study

Journal of Human Hypertension volume 27, pages 309–314 (2013)Cite this article

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Abstract

Hypertensive disorder of pregnancy (HDP) is considered an important determinant in the prediction of future hypertension. The aim of this study is to examine whether HDP improves prediction of future hypertension, over prediction based on established risk factors measured during pregnancy. We used a community based cohort study of 2117 women who received antenatal care at a major hospital in Brisbane between 1981 and 1983 and had blood pressure assessed 21 years after the index pregnancy. Of these 2117 women, 193 (9.0%) experienced HDP and 345 (16.3%) had hypertension at 21 years postpartum. For women with HDP, the odds of being hypertensive at 21 years postpartum were 2.46 (95% CI 1.70, 3.56), adjusted for established risk factors including age, education, race, alcohol, cigarettes, exercise and body mass index. Addition of HDP did not improve the prediction model that included these established risk factors, with the area under the curve of receiver operator (AUROC) increasing from 0.710 to 0.716 (P-value for difference in AUROC=0.185). Our findings suggest that HDP is strongly and independently associated with future hypertension, and women who experience this condition should be counselled regarding lifestyle modification and careful ongoing blood pressure monitoring. However, the development of HDP during pregnancy does not improve our capacity to predict future hypertension, over risk factors identifiable at the time of pregnancy. This suggests that counseling regarding lifestyle modification and ongoing blood pressure monitoring might reasonably be provided to all pregnant and postpartum women with identifiable risk factors for future hypertension.

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Acknowledgements

We thank the MUSP Team, MUSP participants, the Mater Misericordiae Hospital and the Schools of Social Science, Population Health, and Medicine at the University of Queensland for their support; and the National Health and Medical Research Council (NHMRC), Queensland Health, the Centre for Accident Research and Road Safety—Queensland (CARRS-Q), the Australian Institute of Criminology (AIC) and National Heart Foundation for funding this project. We wish to specifically thank members of the MUSP-21-Year Follow-up team including Rosemary Aird, Stacey Allerton, Ruth Armstrong, Samantha Batchelor, Pauline Bonnici, Rachael Bor, Emma Brown, Justine Butcher, Fiona Cameron, Narelle Constantine, Sophie Gudgeon, Jatinder Kaur, Jane Maclean, Amanda Margerison, Kobie Mulligan, Kelly Quinlan, Marie Seeman and Jennifer Winn. DAL works in a Centre that receives funding from the UK Medical Research Council (G0600705) and University of Bristol. A Al Mamun is funded by the NHMRC Career Development Awards in Population Health (ID 519756). The core MUSP study was funded by the National Health and Medical Research Council (NHMRC) of Australia.

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The views expressed in this study are those of the authors and not necessarily any funding body. The authors had full access to all data and no funding bodies influenced the analysis or interpretation of results.

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Authors and Affiliations

  1. Department of Internal Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia

    L K Callaway

  2. School of Medicine, The University of Queensland, Brisbane, Queensland, Australia

    L K Callaway & M D Nitert

  3. School of Population Health, The University of Queensland, Brisbane, Queensland, Australia

    A Mamun, G M Williams & J M Najman

  4. Mater Clinical School, The University of Queensland, Brisbane, Queensland, Australia

    H D McIntyre

  5. MRC Centre for Causal Analyses in Translational Epidemiology, School of Community and Social Medicine, University of Bristol, Bristol, UK

    D A Lawlor

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  1. L K Callaway
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  2. A Mamun
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  3. H D McIntyre
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Correspondence to A Mamun.

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Callaway, L., Mamun, A., McIntyre, H. et al. Does a history of hypertensive disorders of pregnancy help predict future essential hypertension? Findings from a prospective pregnancy cohort study. J Hum Hypertens 27, 309–314 (2013). https://doi.org/10.1038/jhh.2012.45

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  • DOI: https://doi.org/10.1038/jhh.2012.45

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