Hypertension, Vol 23, 717-721, Copyright © 1994 by American Heart Association
CG Solomon, SW Graves, MF Greene and EW Seely
Insulin resistance is associated with and may be causal in essential
hypertension, but the relation between insulin resistance and hypertension
arising de novo in pregnancy is unclear. Transient hypertension of
pregnancy (new-onset nonproteinuric hypertension of late pregnancy) is
associated with a high risk of later essential hypertension and thus may
have similar pathophysiology. To assess the association between glucose
intolerance and subsequent development of proteinuric and nonproteinuric
hypertension in pregnancy in women without underlying essential
hypertension or overt glucose intolerance, we performed a retrospective
case-control study comparing glucose levels on routine screening for
gestational diabetes mellitus among women subsequently developing
hypertension. Women who developed hypertension in pregnancy (n = 97) had
significantly higher glucose levels on 50-g oral glucose loading test (P
< .01) and a significantly higher frequency of abnormal glucose loading
tests (> or = 7.8 mmol/L) (P < .01) than women who remained
normotensive (n = 77). Relative glucose intolerance was particularly common
in women who developed nonproteinuric hypertension. Women who developed
hypertension also had greater prepregnancy body mass index (P < or =
.0001) and baseline systolic and diastolic blood pressures (P < or =
.0001 for both), although all subjects were normotensive at baseline by
study design. However, after adjustment for these and other potential
confounders, an abnormal glucose loading test remained a significant
predictor of development of hypertension (P < .05) and, specifically,
nonproteinuric hypertension in pregnancy (P < .01). Among a subgroup of
women in whom insulin levels were also measured (n = 80), there was a
nonsignificant trend toward higher insulin levels in women developing
hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Glucose intolerance as a predictor of hypertension in pregnancy
Endocrine-Hypertension Division, Brigham and Women's Hospital, Boston, MA 02115.
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