Obesity Linked to Increased Risk for Chronic Hypertension After Hypertensive Disorder in Pregnancy
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The authors of this observational cohort study examined data from the Nurses’ Health Study II (1991–2013) to determine risk factors for developing chronic hypertension in women who had experienced a hypertensive disorder of pregnancy (HDP). They identified a cohort of 54,588 parous women without a history of stroke, myocardial infarction, or chronic hypertension; of these, 5520 (10%) had a history of HDP. In the total cohort, 13,971 cases of chronic hypertension were diagnosed over the follow-up period. Four lifestyle factors were examined to determine their effect on development of chronic hypertension after HDP: body mass index after pregnancy, physical activity, adherence to the DASH diet, and dietary intake of sodium/potassium. Of the four factors examined, only an overweight or obese body mass index after pregnancy was associated with the development of chronic hypertension after HDP.
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The authors conclude that maintaining a healthy body weight is especially important after a pregnancy complicated by HDP to lower the risk of chronic hypertension later in life.
abstract
This abstract is available on the publisher's site.
Access this abstract nowObjectives
To study the association between lifestyle risk factors and chronic hypertension by history of hypertensive disorders of pregnancy (HDP: gestational hypertension and pre-eclampsia) and investigate the extent to which these risk factors modify the association between HDP and chronic hypertension.
Design
Prospective cohort study.
Setting
Nurses' Health Study II (1991-2013).
Participants
54 588 parous women aged 32 to 59 years with data on reproductive history and without previous chronic hypertension, stroke, or myocardial infarction.
Main outcome measure
Chronic hypertension diagnosed by a physician and indicated through nurse participant self report. Multivariable Cox proportional hazards models were used to investigate the development of chronic hypertension contingent on history of HDP and four lifestyle risk factors: post-pregnancy body mass index, physical activity, adherence to the Dietary Approaches to Stop Hypertension (DASH) diet, and dietary sodium/potassium intake. Potential effect modification (interaction) between each lifestyle factor and previous HDP was evaluated with the relative excess risk due to interaction.
Results
10% (n=5520) of women had a history of HDP at baseline. 13 971 cases of chronic hypertension occurred during 689 988 person years of follow-up. Being overweight or obese was the only lifestyle factor consistently associated with higher risk of chronic hypertension. Higher body mass index, in particular, also increased the risk of chronic hypertension associated with history of HDP (relative excess risk due to interaction P<0.01 for all age strata). For example, in women aged 40-49 years with previous HDP and obesity class I (body mass index 30.0-34.9), 25% (95% confidence interval 12% to 37%) of the risk of chronic hypertension was attributable to a potential effect of obesity that was specific to women with previous HDP. There was no clear evidence of effect modification by physical activity, DASH diet, or sodium/potassium intake on the association between HDP and chronic hypertension.
Conclusion
This study suggests that the risk of chronic hypertension after HDP might be markedly reduced by adherence to a beneficial lifestyle. Compared with women without a history of HDP, keeping a healthy weight seems to be especially important with such a history.
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Additional Info
Lifestyle in Progression From Hypertensive Disorders of Pregnancy to Chronic Hypertension in Nurses' Health Study II: Observational Cohort Study
BMJ 2017 Jul 12;358(xx)j3024, S Timpka, JJ Stuart, LJ Tanz, EB Rimm, PW Franks, JW Rich-EdwardsFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.