RESUMO
Resumen: OBJETIVO: determinar la incidencia, a largo plazo, de hipertensión arterial en mujeres con diagnóstico previo de estados hipertensivos del embarazo e identificar los factores clínicos y bioquímicos gestacionales que incrementan el riesgo posterior de padecer hipertensión. MATERIALES Y MÉTODOS: estudio de casos y controles anidados en una cohorte. Se estudiaron las pacientes en quienes se estableció el diagnóstico de estados hipertensivos del embarazo entre 2000 y 2010. Grupo 1: mujeres con diagnóstico de estados hipertensivos del embarazo y posterior inicio de hipertensión arterial. Grupo 2: control de mujeres con diagnóstico de estados hipertensivos del embarazo que durante el tiempo de seguimiento no padecieron hipertensión arterial. Para determinar la potencial asociación entre las variables de estudio con la hipertensión arterial posterior se realizaron pruebas paramétricas y no paramétricas, y para detectar la relación o interacción entre las diferentes variables se estudiaron sus correlaciones. RESULTADOS: se registraron 121 pacientes con estados hipertensivos del embarazo. La incidencia posterior de hipertensión arterial fue de 41.3%. El tiempo promedio transcurrido hasta el diagnóstico de hipertensión arterial fue de 11.7 años (IC 95%: 10.6-12.9). El único factor de riesgo de hipertensión arterial posterior a la gestación índice fue la multiparidad. Ninguno de los demás parámetros estudiados tuvo significación estadística. CONCLUSIONES: los estados hipertensivos del embarazo son un factor de riesgo para el posterior desarrollo de hipertensión arterial. No es posible determinar, con base en los parámetros clínicos o bioquímicos gestacionales, cuáles presentarán una mayor incidencia de hipertensión futura. Todas las gestantes con esta patología deben ser informadas del riesgo hipertensivo a largo plazo.
Abstract: OBJECTIVE: To determine the incidence of long-term hypertension in women who were previously diagnosed of hypertensive pregnancy states. Secondarily identify clinical and biochemical gestational factors that increase the subsequent risk of hypertension. MATERIAL AND METHODS: Study of nested cases and controls in a cohort. Patients were selected who were diagnosed of "hypertensive pregnancy disorders" between 2000 and 2010 and two subgroups were differentiated: Group cases: women diagnosed with "hypertensive pregnancy disorders" and subsequent development of hypertension. - Control group: women with the diagnosis of "hypertensive pregnancy disorders" and who at the time of follow-up did not develop hypertension. The mean time elapsed until the diagnosis of hypertension was 11.79 years (95% CI: 10.6-12.90). Parametric and non-parametric tests were performed to determine the Potential association between the study variables with the later hypertension. In addition, to detect the relationship or interaction between the different variables, their correlations were studied. The influence of the different gestational variables on the subsequent occurrence of arterial hypertension as a function of the time parameter was obtained through the Kaplan Meier survival study and the COX models were applied for the categorical variables. RESULTS: We studied 121 patients diagnosed with "hypertensive pregnancy disorders". The subsequent incidence of hypertension was 41.32%. As a risk factor for posterior hypertension in gestation index, only multiparity was identified. None of the other parameters studied presented statistical significance. CONCLUSIONS: The hypertensive pregnancy disorders are a risk factor for the subsequent development of hypertension. It is not possible to determine, based on clinical or biochemical gestational parameters, which will present a higher incidence of future hypertension. All pregnant women with this pathology should be informed of the long-term hypertensive risk.
RESUMO
Background: The 8 to 10% of pregnancies are affected with hypertensive disorders of pregnancy. They are the most common obstetric complication and present significant maternal and perinatal morbidity and mortality; but also these diseases go beyond pregnancy and determine a group of women with increased cardiovascular risk in your life futura. Cardiovascular disease remains the main cause of death in the Western world and women with a history of pregnancy hypertensive disease, are at increased risk of cardiovascular complications afterwards. Therefore, pregnancy is a unique physiological situation provides an opportunity to identify a group of women who will present cardiovascular risk factors later in life. Objetive: To determine the long-term cardiovascular risk factors (chronic hypertension, type 2 diabetes mellitus, metabolic syndrome) and thyroid dysfunction incidence in women who have previously been diagnosed with "hypertensive disorders of pregnancy". Material and methods: Case-control study with retrospective collection of information from women whose pregnancy and childbirth occurred between 2000 and 2010. Case: Patients with a diagnosis of "hypertensive diseases of pregnancy" (N = 134). Control: random sample of pregnant women who were not diagnosed with hypertensive state of pregnancy and whose gestation was spent in 2000 (n = 145). The mean follow-up of both groups was 10,78 years. We have applied parametric test (T-Student for independent samples), and for those variables that did not meet that condition, we have applied the U of Mann-Whitney test. The Chi-square test was used to compare qualitative variables and Fisher's exact test. For comparison between groups, model univariate logistic regression was performed. Results: The incidence of hypertension was 41,32% in patients with a history of hypertensive pregnancy disease, with a relative risk (RR) was 9,15. The incidence of type 2 diabetes mellitus was 5,17%. Dyslipidemia was diagnosed after at 43,53% with a RR of 3,7. Metabolic syndrome reached 16,83% in the cases population with a RR of 2,63. The incidence of hypothyroidism was 8,11%. Conclusion: Patients who were diagnosed with "hypertensive state of pregnancy" are a group of women at increased risk of developing cardiovascular risk factors later in life.