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Abstract Details

Hypertensive Disorders in Pregnancy and Future Risk of Stroke and Hypertension: A Systematic Review and Meta-analysis
Cerebrovascular Disease and Interventional Neurology
P1 - Poster Session 1 (9:00 AM-5:00 PM)
112
We aimed to evaluate the association between hypertensive disorders in pregnancy (HDP) and future risk of stroke, stroke death, and hypertension.

Hypertensive disorders of pregnancy (HDP) are a unique vascular risk factor among women. They are known to increase the risk of stroke in the peri-partum period, but there is compelling evidence that women with these disorders may continue to be at an elevated vascular risk in later life.

In this meta-analysis (PROSPERO CRD42020179272, MOOSE-compliant), systematic searches were performed in MEDLINE and EMBASE for studies examining stroke and hypertension outcomes in women with HDP. Exposures of interest included the different types of HDP - gestational hypertension, chronic hypertension, and pre-eclampsia/eclampsia. Outcomes of interest included hypertension incidence, stroke incidence, stroke subtype, and stroke mortality. Pooled hazard ratios (aHR) with 95% confidence intervals were adjusted for age at delivery, ethnicity, and vascular risk factors.

Eighteen cohort studies and one case-control study involving over 10 million women were included in the meta-analysis. HDP of any kind was significantly associated with hypertension in later life, although with high heterogeneity (aHR for any HDP:2.83, 95%CI:1.34-6.00, I2:99.8%; pre-eclampsia aHR:2.55, 2.01-3.23, I2:98.7%). HDP of any kind, but especially pre-eclampsia, was also associated with all stroke (aHR for any HDP:1.43, 95%CI:1.22-1.66, I2:80.7%; pre-eclampsia: 1.56, 95%CI:1.38-1.76, I2:60.7%), ischemic stroke (aHR for any HDP:1.72, 95%CI:1.26-2.35, I2:74.7%; pre-eclampsia:2.09, 95%CI:1.63-2.66, I2:74.9%), and hemorrhagic stroke (aHR for any HDP:1.17, 95%CI:1.24-2.36; pre-eclampsia:1.42, 95%CI:1.11-1.82, I2:70.5%), although estimates showed moderate to high heterogeneity. HDP in general, including gestational hypertension alone, was associated with stroke mortality (aHR for any HDP:1.88, 95%CI:1.53-2.32, gestational hypertension:2.97, 95%CI:1.49-5.92, single study).

Increasing severities of HDP carry higher hazards of hypertension and stroke many years later. HDP, including gestational hypertension alone, are also associated with future stroke mortality. Our results should motivate close follow-up of patients with HDP to identify and treat later-life hypertension.
Authors/Disclosures
Aaron R. Switzer, MD
PRESENTER 		Dr. Switzer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai Company Limited.
Eric E. Smith, MD (University of Calgary) Dr. Smith has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. Dr. Smith has received publishing royalties from a publication relating to health care. Dr. Smith has received publishing royalties from a publication relating to health care.
Aravind Ganesh, MD (Department of Clinical Neurosciences, University of Calgary) Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as a Consultant for Figure 1. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Servier Canada. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Dr. Ganesh has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli-Lilly. Dr. Ganesh has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Let's Get Proof (Collavidence Inc). Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for 好色先生 (journals Neurology and Neurology: Clinical Practice). Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association (journal: Stroke). Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers (for Frontiers in Neurology). Dr. Ganesh has or had stock in SnapDx.Dr. Ganesh has or had stock in Collavidence Inc.Dr. Ganesh has or had stock in DataSimpl. The institution of Dr. Ganesh has received research support from Canadian Institutes of Health Research . The institution of Dr. Ganesh has received research support from Alberta Innovates. The institution of Dr. Ganesh has received research support from University of Calgary Centre for Clinical Research. The institution of Dr. Ganesh has received research support from Innovation 4 Health. The institution of Dr. Ganesh has received research support from Government of Canada INOVAIT. The institution of Dr. Ganesh has received research support from Campus Alberta Neuroscience. The institution of Dr. Ganesh has received research support from Alzheimer Society of Canada. The institution of Dr. Ganesh has received research support from Heart and Stroke Foundation of Canada. The institution of Dr. Ganesh has received research support from New Frontiers in Research Fund. The institution of Dr. Ganesh has received research support from Panmure House. The institution of Dr. Ganesh has received research support from Brain Canada. The institution of Dr. Ganesh has received research support from MSI Foundation. The institution of Dr. Ganesh has received research support from France Canada Research Fund. Dr. Ganesh has received intellectual property interests from a discovery or technology relating to health care.