Blood Pressure Characteristics and Early Onset Preeclampsia (page 1338)
Some women develop preeclampsia very early in their pregnancy. Interestingly, such women are also more likely to have a family history of preeclampsia, develop preeclampsia again in subsequent pregnancies, and have a higher risk of later cardiovascular disease. These observations raise the possibility that women develop early onset preeclampsia because they have distinct, heritable, physiological traits that predispose them to both preeclampsia and later cardiovascular disease. In this issue of Hypertension, Lazdam et al report distinct differences in blood pressure characteristics during pregnancy, and <13 years later, in women who develop early onset preeclampsia. They demonstrate for the first time that compared with those with late-onset preeclampsia or normotensive pregnancies, such women have persistently higher blood pressure 6 weeks after delivery, a substantially greater increase in blood pressure over the next decade relative to levels during pregnancy, and significantly higher nocturnal blood pressures in later life. Lazdam et al then studied blood pressure in the offspring and found that those born to the pregnancies complicated by early onset disease had 6 mm Hg higher systolic blood pressure compared with those born to either late-onset disease or normotensive pregnancy. Characterization of the biology that underlies these distinct variations in blood pressure behavior may identify pathways for novel interventions. Furthermore, a diagnosis of early onset disease seems to identify individuals who may warrant targeted blood pressure surveillance.
Determinants of Adolescent Left Ventricular Mass (page 1266)
Cardiac left ventricular hypertrophy is a strong independent predictor of cardiovascular disease morbidity and mortality in adulthood. Left ventricular growth and geometric remodeling in adolescence may have long-term consequences on cardiovascular health in later life. However, factors influencing left ventricular mass in early life are poorly characterized. The determinants of left ventricular mass and patterns of geometric remodeling in healthy adolescents with specific emphasis on birth size and growth in early childhood were studied. Left ventricular measurements were obtained with echocardiography in 418 adolescents at 15 years of age in a prospective atherosclerosis prevention study, Special Turku Coronary Risk Factor Intervention Project (STRIP). Birth weight was directly associated with left ventricular mass, regardless of sex and current weight, pulse pressure, and physical activity level. Growth in early childhood was not associated with left ventricular mass in adolescence. Adolescents who were overweight had 17 g greater left ventricular mass than those with normal body mass index. The results indicate that birth weight has a long-lasting impact on left ventricular mass and normal body weight is beneficial for cardiac structure in adolescents, whereas weight gain during the first 2 years of life does not associate with adolescent left ventricular mass. These data extend the knowledge of the determinants of left ventricular mass from early life to adolescence, relevant for the prevention of cardiovascular disease.
Is Blood Pressure Variability a Risk Factor? (page 1138)
Attempts to anchor blood pressure variability as an established cardiovascular risk factor span ≈30 years. Recent findings challenge the concept of usual blood pressure and led to the proposition to consider blood pressure variability in the diagnosis, treatment, and monitoring of patients with hypertension. Because these findings originated from post hoc analyses within the context of clinical trials in selected high-risk patients or in patients with a history of stroke, confirmation from an unbiased population sample was necessary. In this issue of Hypertension, results from the prospective Flemish Study on Environment, Genes and Health Outcomes (FLEMENGHO) indicate that systolic blood pressure variability does not have any independent prognostic significance over and beyond mean systolic pressure. These findings from 2944 randomly recruited participants, representative of a general population, and followed up for a median of 12 years, suggest that what matters most in the management of hypertension is to reduce the blood pressure level, as recommended in current guidelines. FLEMENGHO results do not support blood pressure variability as an independent risk factor.
- © 2012 American Heart Association, Inc.