| Autor: |
Khosla K; University of Chicago Pritzker School of Medicine, IL (K.K., S.H.)., Heimberger S; University of Chicago Pritzker School of Medicine, IL (K.K., S.H.)., Nieman KM; Katalyses, Ankeny, IA (K.M.N.)., Tung A; Department of Anesthesia and Critical Care (A.T., S.S.), University of Chicago, IL., Shahul S; Department of Anesthesia and Critical Care (A.T., S.S.), University of Chicago, IL., Staff AC; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (A.C.S.).; Division of Obstetrics and Gynaecology, Oslo University Hospital, Norway (A.C.S.)., Rana S; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R.), University of Chicago, IL. |
| Abstrakt: |
Patients with a history of hypertensive disorders of pregnancy (HDP) suffer higher rates of long-term cardiovascular events including heart failure, coronary artery disease, and stroke. Cardiovascular changes during pregnancy can act as a natural stress test, subsequently unmasking latent cardiovascular disease in the form of HDP. Because HDP now affect 10% of pregnancies in the United States, the American Heart Association has called for physicians who provide peripartum care to promote early identification and cardiovascular risk reduction. In this review, we discuss the epidemiology, pathophysiology, and outcomes of HDP-associated cardiovascular disease. In addition, we propose a multi-pronged approach to support cardiovascular risk reduction for women with a history of HDP. Additional research is warranted to define appropriate blood pressure targets in the postpartum period, optimize the use of pregnancy history in risk stratification tools, and clarify the effectiveness of preventive interventions. The highest rates of HDP are in populations with poor access to resources and quality health care, making it a major risk for inequity of care. Interventions to decrease long-term cardiovascular disease risk in women following HDP must also target disparity reduction. |
