Blood Pressure Thresholds for Hypertension in Pregnancy and Future Cardiovascular Risk

To evaluate the impact of blood pressure threshold (≥140/90 vs ≥130/80 mm Hg) and cardiovascular disease (CVD) risk factors on the association of hypertensive disorders of pregnancy (HDP) and CVD. A cohort of parous women 45 years of age were followed up for an average of 18.6 years. Hypertension in...

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Vydané v:	Mayo Clinic proceedings Ročník 100; číslo 10; s. 1745
Hlavní autori:	Kattah, Andrea G, Coutinho, Thais D, Vermunt, Jane, Vaughan, Lisa E, Suvakov, Sonja, Butler Tobah, Yvonne S, Chamberlain, Alanna M, Bielinski, Sue J, Garovic, Vesna
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	England 01.10.2025
Predmet:	Adult Blood Pressure - physiology Blood Pressure Determination - methods Cardiovascular Diseases - epidemiology Cardiovascular Diseases - etiology Female Heart Disease Risk Factors Humans Hypertension Hypertension, Pregnancy-Induced - diagnosis Hypertension, Pregnancy-Induced - epidemiology Hypertension, Pregnancy-Induced - physiopathology Middle Aged Pregnancy Proportional Hazards Models Risk Factors
ISSN:	1942-5546, 1942-5546
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Abstract	To evaluate the impact of blood pressure threshold (≥140/90 vs ≥130/80 mm Hg) and cardiovascular disease (CVD) risk factors on the association of hypertensive disorders of pregnancy (HDP) and CVD. A cohort of parous women 45 years of age were followed up for an average of 18.6 years. Hypertension in pregnancy was defined using 2 thresholds: ≥140/90 and ≥130/80 mm Hg (with more than 50% of readings greater than or equal to threshold after first elevation). Cox proportional hazards models were used to evaluate the association between HDP and CVD after adjusting for CVD risk factors (at age 45 or as time-dependent covariates after 45), age at first pregnancy, and parity. Among 1755 women, 263 (15.0%) had HDP during one or more of their pregnancies using the 140/90 mm Hg or greater threshold, while 780 (44.4%) had HDP based on the 130/80 mm Hg or greater threshold. Adjusting for age at pregnancy, parity, body mass index, and CVD risk factors after age 45, both term and preterm preeclampsia were associated with an increased risk of CVD using the 140/90 mm Hg or greater threshold (hazard ratio (HR), 1.45; 95% CI, 1.00 to 2.09; P=.048; and HR, 2.25; 95% CI, 1.25 to 4.06; P=.007, respectively) and the 130/80 mm Hg or greater threshold (HR, 1.42; 95% CI, 1.01 to 1.99; P=.042; and HR, 1.98; 95% CI, 1.09 to 3.60; P=.024, respectively). Women who had HDP only at 130/80 mm Hg or greater (not ≥140/90 mm Hg) had a lower prevalence of hypertension at 45 years compared with the higher threshold (11.0% [57 of 517] vs 24.7% [63 of 263]; P<.001). Lowering the blood pressure threshold increased the incidence of HDP but did not impact the association of HDP and future CVD.
AbstractList	To evaluate the impact of blood pressure threshold (≥140/90 vs ≥130/80 mm Hg) and cardiovascular disease (CVD) risk factors on the association of hypertensive disorders of pregnancy (HDP) and CVD.OBJECTIVETo evaluate the impact of blood pressure threshold (≥140/90 vs ≥130/80 mm Hg) and cardiovascular disease (CVD) risk factors on the association of hypertensive disorders of pregnancy (HDP) and CVD.A cohort of parous women 45 years of age were followed up for an average of 18.6 years. Hypertension in pregnancy was defined using 2 thresholds: ≥140/90 and ≥130/80 mm Hg (with more than 50% of readings greater than or equal to threshold after first elevation). Cox proportional hazards models were used to evaluate the association between HDP and CVD after adjusting for CVD risk factors (at age 45 or as time-dependent covariates after 45), age at first pregnancy, and parity.PATIENTS AND METHODSA cohort of parous women 45 years of age were followed up for an average of 18.6 years. Hypertension in pregnancy was defined using 2 thresholds: ≥140/90 and ≥130/80 mm Hg (with more than 50% of readings greater than or equal to threshold after first elevation). Cox proportional hazards models were used to evaluate the association between HDP and CVD after adjusting for CVD risk factors (at age 45 or as time-dependent covariates after 45), age at first pregnancy, and parity.Among 1755 women, 263 (15.0%) had HDP during one or more of their pregnancies using the 140/90 mm Hg or greater threshold, while 780 (44.4%) had HDP based on the 130/80 mm Hg or greater threshold. Adjusting for age at pregnancy, parity, body mass index, and CVD risk factors after age 45, both term and preterm preeclampsia were associated with an increased risk of CVD using the 140/90 mm Hg or greater threshold (hazard ratio (HR), 1.45; 95% CI, 1.00 to 2.09; P=.048; and HR, 2.25; 95% CI, 1.25 to 4.06; P=.007, respectively) and the 130/80 mm Hg or greater threshold (HR, 1.42; 95% CI, 1.01 to 1.99; P=.042; and HR, 1.98; 95% CI, 1.09 to 3.60; P=.024, respectively). Women who had HDP only at 130/80 mm Hg or greater (not ≥140/90 mm Hg) had a lower prevalence of hypertension at 45 years compared with the higher threshold (11.0% [57 of 517] vs 24.7% [63 of 263]; P<.001).RESULTSAmong 1755 women, 263 (15.0%) had HDP during one or more of their pregnancies using the 140/90 mm Hg or greater threshold, while 780 (44.4%) had HDP based on the 130/80 mm Hg or greater threshold. Adjusting for age at pregnancy, parity, body mass index, and CVD risk factors after age 45, both term and preterm preeclampsia were associated with an increased risk of CVD using the 140/90 mm Hg or greater threshold (hazard ratio (HR), 1.45; 95% CI, 1.00 to 2.09; P=.048; and HR, 2.25; 95% CI, 1.25 to 4.06; P=.007, respectively) and the 130/80 mm Hg or greater threshold (HR, 1.42; 95% CI, 1.01 to 1.99; P=.042; and HR, 1.98; 95% CI, 1.09 to 3.60; P=.024, respectively). Women who had HDP only at 130/80 mm Hg or greater (not ≥140/90 mm Hg) had a lower prevalence of hypertension at 45 years compared with the higher threshold (11.0% [57 of 517] vs 24.7% [63 of 263]; P<.001).Lowering the blood pressure threshold increased the incidence of HDP but did not impact the association of HDP and future CVD.CONCLUSIONLowering the blood pressure threshold increased the incidence of HDP but did not impact the association of HDP and future CVD. To evaluate the impact of blood pressure threshold (≥140/90 vs ≥130/80 mm Hg) and cardiovascular disease (CVD) risk factors on the association of hypertensive disorders of pregnancy (HDP) and CVD. A cohort of parous women 45 years of age were followed up for an average of 18.6 years. Hypertension in pregnancy was defined using 2 thresholds: ≥140/90 and ≥130/80 mm Hg (with more than 50% of readings greater than or equal to threshold after first elevation). Cox proportional hazards models were used to evaluate the association between HDP and CVD after adjusting for CVD risk factors (at age 45 or as time-dependent covariates after 45), age at first pregnancy, and parity. Among 1755 women, 263 (15.0%) had HDP during one or more of their pregnancies using the 140/90 mm Hg or greater threshold, while 780 (44.4%) had HDP based on the 130/80 mm Hg or greater threshold. Adjusting for age at pregnancy, parity, body mass index, and CVD risk factors after age 45, both term and preterm preeclampsia were associated with an increased risk of CVD using the 140/90 mm Hg or greater threshold (hazard ratio (HR), 1.45; 95% CI, 1.00 to 2.09; P=.048; and HR, 2.25; 95% CI, 1.25 to 4.06; P=.007, respectively) and the 130/80 mm Hg or greater threshold (HR, 1.42; 95% CI, 1.01 to 1.99; P=.042; and HR, 1.98; 95% CI, 1.09 to 3.60; P=.024, respectively). Women who had HDP only at 130/80 mm Hg or greater (not ≥140/90 mm Hg) had a lower prevalence of hypertension at 45 years compared with the higher threshold (11.0% [57 of 517] vs 24.7% [63 of 263]; P<.001). Lowering the blood pressure threshold increased the incidence of HDP but did not impact the association of HDP and future CVD.
Author	Suvakov, Sonja Bielinski, Sue J Butler Tobah, Yvonne S Chamberlain, Alanna M Coutinho, Thais D Kattah, Andrea G Vaughan, Lisa E Garovic, Vesna Vermunt, Jane
Author_xml	– sequence: 1 givenname: Andrea G surname: Kattah fullname: Kattah, Andrea G organization: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN – sequence: 2 givenname: Thais D surname: Coutinho fullname: Coutinho, Thais D organization: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN – sequence: 3 givenname: Jane surname: Vermunt fullname: Vermunt, Jane organization: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN – sequence: 4 givenname: Lisa E surname: Vaughan fullname: Vaughan, Lisa E organization: Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN – sequence: 5 givenname: Sonja surname: Suvakov fullname: Suvakov, Sonja organization: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN – sequence: 6 givenname: Yvonne S surname: Butler Tobah fullname: Butler Tobah, Yvonne S organization: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN – sequence: 7 givenname: Alanna M surname: Chamberlain fullname: Chamberlain, Alanna M organization: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN – sequence: 8 givenname: Sue J surname: Bielinski fullname: Bielinski, Sue J organization: Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN – sequence: 9 givenname: Vesna surname: Garovic fullname: Garovic, Vesna email: Garovic.vesna@mayo.edu organization: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN. Electronic address: Garovic.vesna@mayo.edu
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SubjectTerms	Adult Blood Pressure - physiology Blood Pressure Determination - methods Cardiovascular Diseases - epidemiology Cardiovascular Diseases - etiology Female Heart Disease Risk Factors Humans Hypertension Hypertension, Pregnancy-Induced - diagnosis Hypertension, Pregnancy-Induced - epidemiology Hypertension, Pregnancy-Induced - physiopathology Middle Aged Pregnancy Proportional Hazards Models Risk Factors
Title	Blood Pressure Thresholds for Hypertension in Pregnancy and Future Cardiovascular Risk
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