Hypertension During Pregnancy Agrawal, Akanksha; Wenger, Nanette K.
Current hypertension reports,
09/2020, Letnik:
22, Številka:
9
Journal Article
Recenzirano
Purpose of Review
Hypertensive disorders of pregnancy affect about 5–10% of pregnancies impacting maternal, fetal, and neonatal outcomes. We review the recent studies in this field and discuss the ...pathophysiology, diagnosis, and management of hypertension during pregnancy, as well as the short- and long-term consequences on the cardiovascular health of women.
Recent Findings
Although the American College of Cardiology/American Heart Association revised their guidelines for hypertension in the general population in 2017, hypertension during pregnancy continues to be defined as a systolic blood pressure (SBP) ≥ 140 mmHg and/or a diastolic blood pressure (DBP) ≥ 90 mmHg, measured on two separate occasions. The addition of stage 1 hypertension will increase the prevalence of hypertension during pregnancy, identifying more women at risk of preeclampsia; however, more research is needed before changing the BP goal because a lower target BP has a risk of poor placental perfusion. Women with chronic hypertension have a higher incidence of superimposed preeclampsia, cesarean section, preterm delivery before 37 weeks’ gestation, birth weight less than 2500 g, neonatal unit admission, and perinatal death. They also have a higher risk of developing cardiovascular disease later in life. The guidelines recommend low-dose aspirin for women with moderate and high risk of preeclampsia. While treating pregnant women with hypertension, the effectiveness of the antihypertensive agent must be balanced with risks to the fetus.
Summary
Hypertensive disorders of pregnancy should be appropriately and promptly recognized and treated during pregnancy. They should further be co-managed by the obstetrician and cardiologist to decrease the long-term negative impact on the cardiovascular health of women.
For many years the significance of heart disease in women was vastly underappreciated, and women were significantly underrepresented in cardiovascular clinical research. We now know that ...cardiovascular disease is the leading cause of death for women. Women and men share many similarities in the pathophysiology and manifestations of heart disease. However, as research advances with the continued inclusion of more women, knowledge about gender differences between the female and male heart, both on a physiological and pathophysiological basis, grows. These differences can be found in all domains of cardiovascular health and disease, including heart rhythm, heart failure, coronary disease and valvular disease. Further understanding of gender differences in the heart is crucial for advancing our ability to maintain a healthy population and identify and treat heart disease in both women and men. Specific examples within the spectrum of heart disease will be discussed in this review paper, and areas for further research will be proposed.
The guidelines (Figure 1) graphically explore the spectrum of clinical presentations such that the patient may initially have had chest pain, but at presentation either has minimal or no symptoms; to ...the patient with increasing chest pain or other symptoms; to the patient with persistent chest pain or symptoms; to the patient with cardiogenic shock or acute heart failure; and finally, the patient who presents with a cardiac arrest. Very high-risk features include hemodynamic instability or cardiogenic shock; recurrent or ongoing chest pain, refractory to medical management; acute heart failure presumed secondary to ongoing myocardial ischemia; life-threatening arrhythmias or cardiac arrest after presentation; mechanical complications 5; or recurrent dynamic electrocardiographic changes suggestive of ischemia. Analysis of these components may improve the delivery of care for patients with STEMI and will involve patient education for prompt presentation, the EMS system efficiency, the emergency room contact in the hospital, and transfer to the cardiac catheterization laboratory, ideally in under 90 min 10. The attainment and maintenance of treatment targets include a systolic blood pressure of less than 130 mmHg and a diastolic blood pressure under 80 mmHg as tolerated, LDL-C below 55 mg/dL, and a HgbA1c less than 7% 26, 27.
Preeclampsia, gestational diabetes, or pregnancy-induced hypertension identify a woman at risk for cardiovascular disease. This information should be incorporated into the routine cardiovascular risk ...assessment for women, as a basis for appropriate risk factor screening, counseling, and preventive interventions. There is need for development and validation of a clinometric tool to assess cardiovascular risk and guide management.
Current Status of Cardiac Rehabilitation Wenger, Nanette K., MD, MACP, FACC, FAHA
Journal of the American College of Cardiology,
04/2008, Letnik:
51, Številka:
17
Journal Article
Recenzirano
Odprti dostop
Current Status of Cardiac Rehabilitation Nanette K. Wenger Cardiac rehabilitation is increasingly recognized as an integral component of the continuum of care for patients with cardiovascular ...disease. Its application is a class I recommendation in most contemporary cardiovascular clinical practice guidelines. Despite the documentation of substantial morbidity and mortality benefits, cardiac rehabilitation services are vastly underutilized. The core components of cardiac rehabilitation have been detailedly delineated. Implementation of newly available performance measures offers the potential to enhance referral to, enrollment in, and completion of cardiac rehabilitation.
Cardiovascular Complications of Pregnancy Gongora, Maria Carolina; Wenger, Nanette K
International Journal of Molecular Sciences,
10/2015, Letnik:
16, Številka:
10
Journal Article, Book Review
Recenzirano
Odprti dostop
Pregnancy causes significant metabolic and hemodynamic changes in a woman's physiology to allow for fetal growth. The inability to adapt to these changes might result in the development of ...hypertensive disorders of pregnancy (hypertension, preeclampsia or eclampsia), gestational diabetes and preterm birth. Contrary to previous beliefs these complications are not limited to the pregnancy period and may leave permanent vascular and metabolic damage. There is in addition, a direct association between these disorders and increased risk of future cardiovascular disease (CVD, including hypertension, ischemic heart disease, heart failure and stroke) and diabetes mellitus. Despite abundant evidence of this association, women who present with these complications of pregnancy do not receive adequate postpartum follow up and counseling regarding their increased risk of future CVD. The postpartum period in these women represents a unique opportunity to intervene with lifestyle modifications designed to reduce the development of premature cardiovascular complications. In some cases it allows early diagnosis and treatment of chronic hypertension or diabetes mellitus. The awareness of this relationship is growing in the medical community, especially among obstetricians and primary care physicians, who play a pivotal role in detecting these complications and assuring appropriate follow up.
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