Endothelial dysfunction after hypertensive disorders of pregnancy: A systematic review and meta-analysis

Abstracts / Journal of the American Society of Hypertension 10(4S) (2016) e39–e55 Objective: To compare the change in PP with age among white males (WM), white females (WF), African American males (AAM) and African American females (AAF). Methods: Encounters from university-based primary cardiology clinic with a broad referral base were analyzed; 400 encounters were reviewed for PP; with a total of 100 in each of the categories (WM, WF, AAM and AAF). Each group was individually analyzed for PP in young patients (Young; < 60 years of age) versus old patients (Old;
60 years of age), using a Student’s t-test and reported in mmHg. Mean age in each category is reported in years. Results: PP in Young WM (mean age 50; n ¼ 41) was 48  15 mmHg, and in Old WM (mean age 69; n ¼ 59) was 55  19 mmHg (7 mmHg difference; P ¼ NS). PP in Young WF (mean age 52; n ¼ 27) was 45  9 mmHg, and in Old WF (mean age 70; n ¼ 73) was 59  21 mmHg (14 mmHg difference; P < 0.05). PP in Young AAM (mean age 50; n ¼ 47) was 51  14 mmHg, and in Old AAM (mean age 70; n ¼ 53) was 56  17 mmHg (6 mmHg difference; P ¼ NS). PP in Young AAF (mean age 48; n ¼ 42) was 50  18 mmHg, and in Old AAF (mean age 68; n ¼ 58) was 58  21 mmHg (8 mmHg difference; P < 0.05). Discussion: Hypertension remains a major health problem, especially in the elderly who suffer from mostly isolated systolic hypertension, with elevated pulse pressure, which is an independent risk predictor of cardiac events. In this study, the pulse pressure was higher, as expected, in elderly compared with young patients. However, the widening of pulse pressure reached statistical significance only in females, and was highest in white females, in whom it was twice the pulse pressure increase seen in white males. The overall medical management of hypertension and other cardiovascular risk factors in our cohort was guideline-based and without significant difference among the groups. The reason for this variation is unclear, but may be in part related to the hormonal changes in aging females. These observations are important as they identify significant age-related changes in pulse pressure in females, which may provide some explanation for their elevated cardiovascular risk especially post-menopause. Keywords: Hypertension; Pulse pressure; Gender; Race ENDOTHELIAL FUNCTION P-65 Endothelial dysfunction after hypertensive disorders of pregnancy: A systematic review and meta-analysis Sophie Grand’Maison,1 Louise Pilote,2 Tara Landry,2 Marisa Okano,1 Natalie Dayan.2 1McGill University, Montreal, QC, Canada; 2McGill University Health Center, Montreal, QC, Canada Women with prior hypertensive disorders of pregnancy (HDP) are at twice the risk of cardiovascular disease (CVD) than women with prior normotensive pregnancy, possibly due to accelerated vascular aging following endothelial dysfunction (ED) in pregnancy. The aim of this work is to summarize evidence of persistent ED following HDP, as measured by serum biomarkers or imaging techniques. Articles in all languages published from January 1996 to May 2015 were retrieved from MEDLINE, Embase, BIOSIS Previews, CINAHLPlus, and Cochrane. Studies included were observational with HDP as the main exposure and ED as the main outcome assessed at least 3 months post-partum via serum biomarkers or imaging techniques. We pooled results for each modality using a random effects model and present results as weighted mean difference (WMD) with 95% confidence interval (CI) between measures of ED in women with and without prior HDP. We assessed heterogeneity with the I2 method and publication bias by visual inspection of funnel plots. Of 4912 potentially relevant studies, 64 were included in the final analysis evaluating 10 imaging modalities and 11 biomarkers. Duration of follow-up ranged from 3-480 months. There was significantly more ED in women with prior HDP: pulse-wave velocity (PWV; WMD 0.64m/s 95%CI 0.17-1.11), carotid intima-media thickness (WMD 0.03mm 95%CI 0.01-0.04), augmentation index (AIx; WMD 5.9% 95%CI (1.6-10.1), flow-mediated dilatation

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(FMD; WMD -3.9% 95%CI -5.7- -2.2) and soluble fms-like tyrosine kinase-1 (WMD 8.7pg/ml 95%CI 5.6-11.9). There was substantial heterogeneity for FMD, AIx and PWV (I2 90, 89 and 82% respectively), which was not explained by age, duration of follow-up, study design or type of HDP. There was no evidence of publication bias. This study provides evidence that ED persists following HDP as assessed by both imaging and biomarker techniques. Longer-term studies are needed to assess whether ED persists at the time of CVD event in women with prior HDP. Keywords: Endothelial fonction; Hypertensive disorders of pregnancy; Biomarkers; Imaging EPIDEMIOLOGY/SPECIAL POPULATIONS P-66 ‘Skin autofluorescence examination’ as a diagnostic tool for mild cognitive impairment in prehypertensives Michiya Igase,1 Katsuhiko Kohara,3 Yasuharu Tabara.2 1Ehime University, Ehime, Japan; 2Kyoto University Graduate School of Medicine, Kyoto, Japan; 3National Hospital Organization Ehime Medical Center, Ehime, Japan Background: Accumulation of advanced glycation endproducts (AGEs) are thought to be involved in the pathogenesis of Alzheimer’s disease. However, possible involvement of AGEs in conditions of mild cognitive impairment (MCI) have not been fully investigated. Purpose: We aimed to study whether tissue AGE accumulation is associated with cognitive functions. Methods: We analyzed 215 middle-aged-to-elderly community-dwelling prehypertensives persons. We performed MCI screening test and non-invasive skin autofluorescence (SAF, a measure of tissue AGE accumulation levels) on people aged >40 years. MCI was assessed using the Japanese version of the MCI screening method. Results: SAF was significantly higher in participants with MCI than in those with normal cognitive function (2.510.56 vs. 2.110.41; p < 0.001). Logistic regression analyses with confounding factors including age, sex, estimated glomerular filtration rate, brachial ankle pulse wave velocity and BNP showed that a 1 unit increase in SAF had a persecutive effect against the development of MCI (odds ratio: 4.43; 95% CI: 1.19-16.43; p ¼ 0.026). Conclusions: We found inverse associations of SAF, a non-invasive marker for tissue AGEs, with cognitive function, which were independently of other vascular risk factors. Keywords: MCI; AGEs; SAF; prehypertension

Figure 1.