Prediction model for hypertension after preeclampsia in initially normotensive women; the Queen of Hearts cohort

Abstract Background Timely detection and treatment of hypertension prevents cardiovascular diseases. Formerly preeclamptic women are at increased risk for hypertension, but targeted and structural follow-up of these women is lacking. Purpose To develop a prediction model for the development of hypertension in the decade following preeclampsia in women who were initially normotensive shortly after pregnancy. Methods In this longitudinal cohort study, formerly preeclamptic women were invited twice for a cardiovascular assessment. The first visit took place at a median interval of 10 months after delivery and a second visit 10 years later as part of the Queen of Hearts cohort study on early detection of heart failure among young women with a history of preeclampsia (ClinicalTrials.gov Identifier NCT02347540). Normotensive women at the first visit were divided in two groups whether or not they had developed hypertension during visit 2. Hypertension was defined as SBP ≥130 mmHg and/or DBP ≥80 mmhg and/or use of antihypertensive medication. We developed a prediction model using multivariable logistic regression analysis. The model was internally validated with bootstrapping techniques. Results Of the 259 women, 185 (71%) were normotensive at first visit of which 49 (26%) had developed hypertension at the second visit. The prediction model, based on birth weight centile, mean arterial pressure, total cholesterol, left ventricular mass index and left ventricular ejection fraction, had a good to excellent discriminative ability of AUC-ROC-curve 0.82 (95% CI 0.75–0.89) with an optimism corrected AUC of 0.80. Sensitivity and specificity of our model to predict yearly 10% risk to develop hypertension was 98% and 65% respectively and positive- and negative-predictive values were 50% and 99% respectively. Conclusions Based on five easily available variables, we developed a good-to-excellent performing predictive tool to identify incident hypertension following preeclampsia in women that were normotensive shortly after pregnancy. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): This work was partially supported by funding of de Nederlandse Hartstichting (Dutch Heart Foundation, grant number: 2013T084, Queen of Hearts study)