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

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.

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.

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).

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.