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Hypertensive disorders of pregnancy are an important cause of morbidity and mortality, impacting on both maternal and fetal wellbeing. Affected women are at higher risk of future cardiovascular morbidity and mortality. Our study objective was to assess differences in cardiovascular function in pregnant women previously affected by gestational hypertension or preeclampsia. Pregnant women diagnosed with gestational hypertension or preeclampsia in a previous pregnancy were recruited at the start of a subsequent pregnancy and compared to healthy pregnant and non-pregnant controls. All patients underwent pulse wave analysis and echocardiography. Indexes of echocardiography-derived arterial and left ventricular elastance were calculated. In our study women with prior hypertension (n = 25) were more likely to have blood pressure in the 120-139/80-99 mmHg (prehypertension) range. Women with previous hypertension in pregnancy had increased late diastolic transmitral flow velocities (A wave) and increased augmentation index. Women without prior hypertension (n = 50) demonstrated more compliance (reduced EaI and Ees) compared to the non-pregnant controls (n = 40). This adaptation was not seen in pregnancy with prior hypertension, where increased arterial stiffness was observed. In conclusion we have shown increased prevalence of prehypertension and increased arterial stiffness in pregnant women previously affected by gestational hypertensive disease. An increased atrial component to ventricular filling reflects altered diastolic function after hypertensive pregnancy. These women are at increased future cardiovascular risk due to altered cardiac and vascular function and require effective risk mitigation.

Hypertension affects around half of the adult population worldwide, being one of the most common cardiovascular disorders. On a population basis, high blood pressure is considered to be the major independent risk factor for atrial fibrillation (AF). The incidence of both diseases has increased significantly in the recent decades and it is expected to continuously surge in the following years. Due to close relation between the both diseases and their frequent coexistence, hypertension and AF become major health priorities. The multidirectional linking between raised blood pressure and AF is based on complex associations including structural, hemodynamic, neuroendocrine, and autonomic mechanisms. Hypertension provokes excessive fibroblasts proliferation and increased collagen accumulation. It also stimulates cardiomyocytes apoptosis and inflammation, leading to diffused fibrosis and left ventricular hypertrophy development. This is mainly driven by renin-angiotensin-aldosterone system (RAAS) activation, and autonomic dysregulation. Moreover, exposure on long-term stretch due to hypertension causes arterial stiffness with subsequent systolic and diastolic function loss resulting in further heart muscle remodeling. All these pathological changes combined seem influence on myocardial electrical activity, triggering AF development. Given the prevalence and frequent lack of symptoms of both disorders, opportunistic arrhythmia screening in hypertensive patients is needed. In all individuals with established diagnosis of AF, adequate anticoagulation has to be considered for stroke prevention. Blood pressure control is also an essential component of a holistic approach to AF care.

Renal dysfunction is frequently associated with left ventricular (LV) hypertrophy and diastolic dysfunction in hypertensive patients. Limited data exist on renal dysfunction and diastolic impairment among British ethnic minorities with hypertension. We studied associations between renal impairment and diastolic dysfunction in hypertensive subjects of African-Caribbean and South Asian origin. Five hundred and ten hypertensive subjects with ejection fraction greater than or equal to55% and with no history of ischaemic heart disease/valve pathology were included from the original population of the Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES). Diastolic function and cardiac remodelling were measured by echocardiography. LV hypertrophy was common and present in 62% of patients with normal estimated glomerular filtration rate (eGFR, >90 ml min−1 per 1.73 m2), 73% in those with eGFR 60–89 ml min−1 per 1.73 m2 and 87% with eGFR

Endothelial dysfunction and diurnal variation of blood pressure: night secrets of arterial hypertension?