Hypertensive pregnancies need rigorous follow up

Women who have hypertensive complications during pregnancy are at increased risk for developing chronic kidney disease and end-stage renal disease, shows a study in the Canadian Medical Association Journal.

"It also highlights one of the current pitfalls of clinical practice: although these women have great attention paid to their high blood pressure during pregnancy, there is no structured follow up of blood pressure or cardiovascular and renal risk factors after pregnancy," say Julia Spaan (Maastricht University Medical Center, the Netherlands) and Mark Brown (University of New South Wales, Sydney, Australia) in an accompanying commentary.

The risk for end-stage renal disease increased with the severity of the hypertensive disorder; women with gestational hypertension had a 9.03-fold increased risk, whereas those with pre-eclampsia or eclampsia had a 14.0-fold increased risk. These associations were independent of confounders including coronary artery disease, congestive heart failure, and hyperlipidemia.

After controlling for hypertension and diabetes that occurred after pregnancy, the increased risk for end-stage renal disease was substantially attenuated, to a still significant 2.72-fold increase in all women with hypertensive pregnancies relative to those without.

This shows that hypertension and diabetes "account for a large portion of the risk attributed to hypertensive disorders during pregnancy and that these may be intermediate steps in the development of end-stage renal disease," say study author Fung-Chang Sung (China Medical University Hospital, Taichung, Taiwan) and co-workers.

The researchers drew their findings from data on 26,651 women who were aged between 19 and 40 years and had a hypertensive pregnancy between 1998 and 2009. They matched each woman by age and index date to eight women whose pregnancies were not complicated by hypertensive disorders.

The unadjusted incidence rates of chronic kidney disease were 7.24 per 10,000 person-years in women with hypertensive complications and 0.67 per 10,000 person-years in those without. Spaan and Brown note that the Taiwanese population has a relatively high rate of chronic kidney disease; however, the associations with hypertensive pregnancies match previous findings from a Norwegian cohort, making it likely that they are widely applicable.

Spaan and Brown stress that hypertensive pregnancies also raise women's risk for later cardiovascular disease.

"Ideally, cardiovascular risk management would follow a few months after a hypertensive pregnancy in a multidisciplinary approach, including general practitioners, renal and internal medicine specialists, cardiologists, obstetricians, dietary and physical therapists," they say. "A prominent role should be given to lifestyle interventions to promote a healthy lifestyle in these young families."

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