Exercise Stress Echocardiography Unmasks Subclinical Cardiovascular Dysfunction in Midlife Women Following Hypertensive Disorders of Pregnancy

Background: Hypertensive disorders of pregnancy (HDP) are a risk factor for early cardiovascular disease in women, perhaps related to adverse cardiovascular reactivity to physiologic stress. Objectives: To evaluate the association of HDP subtypes with exercise stress echocardiography parameters. Methods: This retrospective cohort study linked exercise stress echocardiograms with delivery records. HDP was classified as none, gestational hypertension (GH), and preeclampsia (PEC). We compared features of treadmill exercise stress echocardiography among HDP groups, adjusted for maternal demographic characteristics, time between delivery and stress testing, resting blood pressure (BP), and exercise duration. Results: Among 885 women with matching delivery and exercise echocardiography records (41.4plus-or-minus sign7.4 years at exercise exam), 92 (10.4%) experienced GH and 39 (4.4%) experienced PEC. Women with PEC were referred for exercise stress testing 3.1 years earlier following delivery (p<0.001) and had shorter exercise duration (lower case Greek beta]=-69.6 seconds [95% CI -115.9, -23.4], p=0.003) than those without HDP. Women with GH had higher peak exercise systolic BP (lower case Greek beta=8.96 mmHg [95% CI 4.89, 13.04], p<0.001), diastolic BP (lower case Greek beta=2.67 mmHg [95% CI 0.24, 5.10], p=0.031), and pulse pressure (lower case Greek beta=8.25 mmHg [95% CI 4.11, 12.39], p<0.001) than those without HDP. Women with GH and PEC were twice as likely to have concentric remodeling and more adverse diastolic parameters on echocardiography than those without HDP (p<0.05). Conclusions: Exercise stress echocardiography may detect subclinical cardiovascular dysfunction in midlife women following HDP, with adverse findings differing by subtype: GH was associated with higher peak exercise BP and PEC with lower exercise capacity.