Volume 112, Issue 3 p. 286-292

Cardiovascular death in women who had hypertension in pregnancy: a case–control study

Gerdur A. Arnadottir

Gerdur A. Arnadottir

a Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland

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Reynir T. Geirsson

Reynir T. Geirsson

a Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland

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Reynir Arngrimsson

Reynir Arngrimsson

a Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland

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Lilja S. Jonsdottir

Lilja S. Jonsdottir

a Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland

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Örn Olafsson

Örn Olafsson

a Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland

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First published: 12 January 2005
Citations: 94
Dr R. T. Geirsson, Department of Obstetrics and Gynecology, Landspitali University Hospital, 101 Reykjavik, Iceland.

Present address: Gardabaer health Center, Iceland.

Abstract

Objective  To determine whether an association exists between hypertension in pregnancy and later development of cardiovascular disease.

Design  Case–control study of women who delivered with and without hypertensive complications during the same period.

Setting  University Hospital in Reykjavik, Iceland.

Population  Three hundred and twenty-five women with hypertension in pregnancy (blood pressure ≥140/90 mmHg after 20 weeks of gestation) in the years 1931–1947, graded by severity. For each case, two normotensive control women, delivering before or after the case and matched for parity and age were selected, giving a total of 629 women.

Methods  Causes of death were evaluated for the presence of ischaemic heart disease, cerebrovascular events and cancer, up until the end of 1996.

Main outcome measures  Survival curves, median survival times, risk of death by age group and severity of disease.

Results  Death with evidence of ischaemic heart disease was more common in cases (24.3%) than in control women (14.6%) (RR 1.66; 95% CI 1.27–2.17). Cerebrovascular event deaths occurred in 9.5% of cases and in 6.5% of controls (RR 1.46; 95% CI 0.94–2.28). Cancer death rates were not different (RR 1.22; 95% CI 0.91–1.63). Survival times were shorter on average by three to nine years as a consequence of cardiovascular disease. This varied by age group in the index pregnancy for women with a history of hypertension in pregnancy. The effect was smaller if the case pregnancy occurred at a young age. There was a linear trend with increasing severity of hypertensive disease in pregnancy in death rates from ischaemic heart disease (χ21= 5.8, P= 0.02).

Conclusions  Long term follow up suggests an increased risk of death from ischaemic heart disease and cerebrovascular events among women who suffered hypertension in pregnancy.