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Stroke: Hypertensive disorders of pregnancy, how does it affect stroke risk?

 Last Update: 2022-01-23
 Source: Internet
 Author: User

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About 5% to 10% of pregnancies are complicated by hypertensive disorders of pregnancy (HDP), with an estimated global incidence of 15.
83 million in 2017
.

HDP is divided into 4 subtypes: chronic hypertension (HTN), chronic HTN with superimposed preeclampsia, preeclampsia/eclampsia, and gestational hypertension

A possible mechanism is insulin resistance, a marker of pregnancy that peaks in the third trimester and rapidly returns to pre-pregnancy levels after delivery; it may play a role in HDP and is associated with basal HTN
.

On the other hand, placental ischemia, LDL intoxication, immune maladaptation, and genetic imprinting have also been reported as possible causes of preeclampsia

Because of these different underlying etiologies, it would be interesting to investigate whether different HDP subtypes have distinct patterns of late vascular disease
.

A review of the literature revealed that a questionnaire study reported that women with a history of hypertension during pregnancy had an increased risk of being subsequently diagnosed with stroke compared with women without such a history (estimated event rate of 12% versus 5%).

Among the different HDP subtypes, preeclampsia-eclampsia, the most studied subtype, was reported in a meta-analysis to have a relative risk of stroke of 1.
81 (95% CI, 1.
45-2.
27) after 10 years of follow-up
.

However, to date, no study has investigated the relationship between the 4 HDP subtypes and 2 stroke subtypes, hemorrhagic and ischemic stroke

In this 17-year nationwide cohort study, Shih-Kai Hung et al, Dalin Tzu Chi Hospital, Taiwan, China, assessed bleeding and ischemic stroke risk in women with HDP stratified by duration of follow-up
.

They reviewed data on 17,588 women aged 18 to 45 years with a history of HDP in Taiwan from 2000 to 2017
.

After matching for confounders, 13 617 HDP women and 54 468 non-HDP women were recruited

They found that the adjusted hazard ratio (aHR) for stroke in women with HDP was 1.
71 (95% CI, 1.
46-2.
00), and the adjusted hazard ratio (aHR) for ischemic and hemorrhagic stroke was 1.
60 (1.
35-1.
89) and 2.
98 ( 2.
13-4.
18) (all P<0.
001)
.

The overall stroke risk in the HDP group remained 2.
04-fold (1.
47-2.
83, P<0.
001) at 10 to 15 years postpartum
.

Although the risk of both ischemic and hemorrhagic stroke persisted, the temporal trends in risk varied

The risk of ischemic stroke peaked at 1-3 years postpartum, with aHR of 2.
14 (1.
36-3.
38), while the risk of hemorrhagic stroke increased gradually, with aHR of 4.
64 (2.
47-8.
73) after 10-15 years postpartum (both P<0.
001)
.

Among the 4 HDP subtypes, chronic hypertension plus preeclampsia had the highest risk of stroke (aHR=3.
86, 1.
91-7.
82, P<0.
001), followed by preeclampsia-eclampsia (aHR= 2.
00,
1.

63- 2.

Chronic prehypertension had the lowest stroke risk (aHR=1.
27, 0.
97-1.
68, P>0.
05)
.

In addition, the aHR of multiple HDP combined with preeclampsia was 5.
48 (1.
14-26.
42, P<0.
05)
.

The significance of the study is that it found that: The effect of HDP on future stroke risk, both ischemic and hemorrhagic, persisted for 17 years
.
The presence of multiple HDPs and preeclampsia further increases the risk of stroke
.

The effect of HDP on future stroke risk persisted for 17 years, both for ischemic and hemorrhagic strokes

Original source:
Hung SK, Lee MS, Lin HY, et al.
Impact of Hypertensive Disorders of Pregnancy on the Risk of Stroke Stratified by Subtypes and Follow-Up Time.
Stroke.
Published online January 5, 2022:STROKEAHA.
121.
034109.
doi: 10.
1161/STROKEAHA.
121.
034109.

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