Public Release: 

Having hypertension during pregnancy may affect cardiovascular health for life

Embargoed news from Annals of Internal Medicine

American College of Physicians

  1. Women who experience hypertensive disorders during pregnancy are at high risk for developing high blood pressure, diabetes, and high cholesterol later in life

Abstract: http://annals.org/aim/article/doi/10.7326/M17-2740

Editorial: http://annals.org/aim/article/doi/10.7326/M18-1443

URLs go live when the embargo lifts

Women with a history of preeclampsia or gestational hypertension in pregnancy developed chronic hypertension at a 2- to 3-fold higher rate and had 70 percent and 30 percent higher rates of type 2 diabetes and high cholesterol, respectively, than women who had normal blood pressure in pregnancy. These findings suggest that women with pregnancies complicated by high blood pressure may benefit from cardiovascular screening throughout their lives. The study is published in Annals of Internal Medicine.

Between 10 to 15 percent of women experience hypertensive complications during pregnancy, such as preeclampsia or gestational hypertension, and substantial evidence shows that these women are more likely to have a heart attack or stroke later in life, even if their blood pressure returns to normal immediately following pregnancy. What is less clear is to what extent they are also more likely to develop cardiovascular disease risk factors and when these risk factors begin to emerge after pregnancy.

Researchers from Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health studied more than 58,000 women enrolled in the Nurses' Health Study II (NHS II) who did not have cardiovascular disease or risk factors at the time of enrollment and had given birth at least once. Women were followed for self-reported physician diagnosed chronic hypertension and high cholesterol and confirmed type 2 diabetes from their first birth through 2013 with a mean follow up of 25 to 32 years. Compared to women who had normal blood pressure in pregnancy, those with preeclampsia or gestational hypertension were significantly more likely to develop cardiovascular risk factors throughout follow-up and also developed these risk factors at younger ages and sooner after pregnancy.

According to the researchers, these findings suggest that preeclampsia and gestational hypertension can alert women and their health care providers about their future cardiovascular health. In addition to screening, women who have had these common pregnancy complications should tell their doctor and adopt a heart healthy diet and lifestyle, just as they would if they had a family history of cardiovascular disease.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Jennifer Stuart, ScD, please contact, Elaine St. Peter at estpeter@bwh.harvard.edu.

  1. Regular marijuana use is associated with development of respiratory issues

Abstract: http://annals.org/aim/article/doi/10.7326/M18-0522

URLs go live when the embargo lifts

Low-strength evidence suggests that regular marijuana use (at least once per week for a year) is associated with cough, sputum production, and wheezing. Researchers did not find enough evidence to determine the effect of marijuana use on lung function. The results of a systematic review and meta-analysis are published in Annals of Internal Medicine.

Marijuana use is on the rise in the U.S., with approximately 13 percent of adults and 21 percent of young adults using on a regular basis. Its widespread use and increasing social acceptance mean that a better understanding of its health effects is needed. Since smoking remains the main method of consumption, similarities between marijuana and tobacco smoke are concerning from a public health perspective.

Researchers from the National Institutes of Health reviewed data from 22 published studies to determine the association between marijuana use and respiratory symptoms, pulmonary function, and obstructive lung disease among adolescents and adults. Two prospective studies showed that marijuana use was associated with an increased risk for respiratory issues. Data on pulmonary function and obstructive lung disease were insufficient. The authors suggest long-term longitudinal studies examining the long-term pulmonary effects of daily marijuana use.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Mehrnaz Ghasemiesfe, MD, please contact her directly at Mehrnaz.Ghasemiesfe@va.gov.

  1. Genomic testing can identify less common diagnoses that affect patient care

Abstract: http://annals.org/aim/article/doi/10.7326/L18-0177

URLs go live when the embargo lifts

Genomic testing can identify alternative and less common diagnoses that have important consequences for treatment and management. Researchers used the example of a 69 year-old woman who had been diagnosed with autosomal dominant polycystic kidney (ADPKD) disease to illustrate this point. Their case report is published in Annals of Internal Medicine.

Patients with bilateral renal cysts, hypertension, and chronic kidney disease are typically diagnosed with ADPKD. Physicians treated a woman with a family history of ADPKD from a paternal aunt and cousin, but not her father. After receiving a kidney from one of her adult daughters, the patient continued to develop benign renal cysts in the donated kidney. A genomic test revealed the mutation that causes the Birt- Hogg- Dube syndrome, a rare genetic disorder that increases the risk for certain types of tumors. This information helped the physicians determine an appropriate treatment strategy for managing her condition. According to the authors, this case shows how genomic testing can be used to find rare diagnoses that can affect treatment decisions.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Meyeon Park, MD, please contact her directly at Meyeon.Park@ucsf.edu.

Also new in this issue:

Finding the Funny - Everything

Jade R. Blue, BA (Hons)

Annals Graphic Medicine

Abstract: http://annals.org/aim/article/doi/10.7326/G17-0019

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