Lifestyle in progression from hypertensive disorders of pregnancy to chronic hypertension in Nurses’ Health Study II: observational cohort study

Jul 14, 2017BMJ (Clinical research ed.)

How lifestyle affects the development from pregnancy-related high blood pressure to long-term high blood pressure in nurses

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Abstract

10% (n=5520) of women had a history of hypertensive disorders of pregnancy at baseline.

13,971 cases of chronic hypertension occurred during 689,988 person years of follow-up.
Being overweight or obese was consistently associated with a higher risk of chronic hypertension.
Higher body mass index increased the risk of chronic hypertension among those with a history of hypertensive disorders of pregnancy.
In women aged 40-49 years with previous hypertensive disorders of pregnancy and obesity class I, 25% of the risk of chronic hypertension was linked to obesity.
No significant effect modification was observed for physical activity, DASH diet adherence, or dietary sodium/potassium intake concerning the association between hypertensive disorders of pregnancy and chronic hypertension.

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To study the association between lifestyle risk factors and chronic hypertension by history of hypertensive disorders of pregnancy (HDP: gestational hypertension and pre-eclampsia) and investigate the extent to which these risk factors modify the association between HDP and chronic hypertension. Prospective cohort study. Nurses' Health Study II (1991-2013). 54 588 parous women aged 32 to 59 years with data on reproductive history and without previous chronic hypertension, stroke, or myocardial infarction. Chronic hypertension diagnosed by a physician and indicated through nurse participant self report. Multivariable Cox proportional hazards models were used to investigate the development of chronic hypertension contingent on history of HDP and four lifestyle risk factors: post-pregnancy body mass index, physical activity, adherence to the Dietary Approaches to Stop Hypertension (DASH) diet, and dietary sodium/potassium intake. Potential effect modification (interaction) between each lifestyle factor and previous HDP was evaluated with the relative excess risk due to interaction. 10% (n=5520) of women had a history of HDP at baseline. 13 971 cases of chronic hypertension occurred during 689 988 person years of follow-up. Being overweight or obese was the only lifestyle factor consistently associated with higher risk of chronic hypertension. Higher body mass index, in particular, also increased the risk of chronic hypertension associated with history of HDP (relative excess risk due to interaction P<0.01 for all age strata). For example, in women aged 40-49 years with previous HDP and obesity class I (body mass index 30.0-34.9), 25% (95% confidence interval 12% to 37%) of the risk of chronic hypertension was attributable to a potential effect of obesity that was specific to women with previous HDP. There was no clear evidence of effect modification by physical activity, DASH diet, or sodium/potassium intake on the association between HDP and chronic hypertension. This study suggests that the risk of chronic hypertension after HDP might be markedly reduced by adherence to a beneficial lifestyle. Compared with women without a history of HDP, keeping a healthy weight seems to be especially important with such a history. Objectives Design Setting Participants Main outcome measure Results Conclusion

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Lifestyle in progression from hypertensive disorders of pregnancy to chronic hypertension in Nurses’ Health Study II: observational cohort study

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