Female- and age-specific reference values for blood pressure and its relationship with cardiac aberrations after pre-eclampsia.

AIMS: Cardiovascular risk increases progressively increases from lower blood pressure (BP) values in females than males, questioning current universal thresholds for hypertension. In this study, we established female- and age-specific thresholds for hypertension and assessed its association with subclinical cardiac aberrations in a high-risk female group of women after pre-eclampsia.

METHODS: A standardized cross-sectional cardiovascular assessment was performed among former pregnant women, including 30-minutes BP measurement and transthoracic echocardiography to assess cardiac function and remodelling. Women with a history of normotensive pregnancy constituted the cardiovascular healthy reference group, in whom we established thresholds for elevated BP (≥95th percentile). The risk for subclinical cardiac aberrations in case of elevated BP was evaluated among former pre-eclamptic women.

RESULTS: A number of 463 women were included in the healthy reference group and 951 formerly pre-eclamptic women (43 ± 8 and 39 ± 8 years, respectively). Female-specific thresholds defining hypertension were 132.8 mmHg systolic or 81.0 mmHg diastolic. Among former pre-eclamptic women, systolic BP levels above ≥132.8 mmHg but below current diagnostic threshold for hypertension (<140 mmHg) significantly associated with increased odds for left ventricular concentric remodelling [OR = 2.1, 95% confidence interval (CI) 1.1-4.2], diastolic dysfunction [OR = 4.5 (1.4-14.2)], and subclinical heart failure (OR = 2.3, 95% CI 1.2-4.2).

CONCLUSION: For relatively young women, female-specific thresholds for hypertension are lower than ESC/ESH guidelines (≥133/81 vs. ≥140/90 mmHg), and associate with cardiac dysfunction in formerly pre-eclamptic women. Sex- and age-tailored interpretation of BP improves prevention of heart failure development and progression among high-risk women.