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Abstract-Aim of our study was to ascertain, prospectively, whether serum uric acid is a suitable predictor of preeclampsia and/or the delivery of small-for-gestational-age infants in women with gestational hypertension. We screened 206 primiparas, with a singleton pregnancy, referred for recent onset of hypertension. At presentation, we measured serum uric acid, creatinine, blood glucose, hemoglobin and platelet level, and 24-hour proteinuria, as well as office and 24-hour blood pressures. We followed the women until 1 month after delivery and recorded pregnancy outcome. After logistic regression analysis, uric acid resulted a significant predictor of preeclampsia, with an unadjusted odds ratio of 9.1 (95% CI: 4.8 to 17.4; PϽ0.001); after adjustment for age, gestation week, hemoglobin and platelet levels, serum creatinine, office and 24-hour average systolic and diastolic blood pressures, it was 7.1 (95% CI: 3.2 to 15.7; PϽ0.001). Regarding the association between maternal serum uric acid and the chance of giving birth to a small-for-gestational-age infant, the unadjusted odds ratio was 1.7 (95% CI: 1.4 to 2.2; PϽ0.001), and it was 1.6 (95% CI: 1.1 to 2.4; Pϭ0.02) after adjustment. Receiver operating characteristic analysis showed that serum uric acid, at a 309-mol/L cutoff, predicted the development of preeclampsia (area under the curve: 0.955), with 87.7% sensitivity and 93.3% specificity, and the delivery of small-for-gestational-age infants (area under the curve: 0.784) with 83.7% sensitivity and 71.7% specificity.In conclusion, the results of our study show that serum uric acid is a reliable predictor of preeclampsia in women referred for gestational hypertension. (Hypertension. 2011;58:704-708.)Key Words: uric acid Ⅲ preeclampsia Ⅲ gestational hypertension Ⅲ blood pressure Ⅲ small for gestation age H ypertensive disorders complicate Ϸ2% to 10% of all pregnancies. 1,2 Among these, preeclampsia remains one of the largest single causes of maternal and fetal mortality and morbidity, whereas uncomplicated gestational hypertension carries a far better prognosis. Clinical prediction of preeclampsia may facilitate initiation of timely management to avert mortality and morbidity in the mother and infant. Raised serum uric acid (UA) is one of the characteristic findings in preeclampsia. In clinical practice, serum UA determination is considered to be a part of the workup in women with preeclampsia to monitor disease severity and aid management of these women. The association between raised serum UA and preeclamptic pregnancies was first reported almost a century ago. 3 Reduced UA clearance secondary to reduced glomerular filtration rate, increased reabsorption, and decreased secretion may be at the origin of elevated serum levels in women with preeclampsia. 4,5 Several studies have reported a positive correlation between elevated maternal serum UA and adverse maternal and fetal outcomes. 6 -10 A number of studies 11-15 have evaluated several tests and parameters, including UA, during the first or second trimester of...

30-year data are presented on blood pressure and cardiovascular morbidity and mortality for 144 nuns living in a secluded order in six nunnerlie in Umbria, central Italy and 138 lay women from the same region. There were no significant differences at baseline regarding age, blood pressure, body mass index, race, ethnic background, menarche, family history of hypertension or 24-hour urinary sodium excretion. None of the women were smokers and none took birth control pills nor did they use estrogen replacement therapy. During the observation period blood pressure remained remarkably stable among the nuns. None showed a rise in diastolic blood pressure to above 90 mm Hg. On the contrary the lay women showed the expected rise in blood pressure with age. This resulted in a gradually greater difference (delta > 30/15 mm Hg) in blood pressure between the two groups, which was statistically significant. There were 31 fatal and 69 non-fatal cardiovascular events during the 30 years of follow-up. These were significantly more common in the lay women, 10 vs. 21 fatal and 21 vs. 48 non-fatal in the nuns and lay women respectively. It appears reasonable to assume that the difference in psychosocial stress is the main underlying factor for the observed findings.

In this study we examined breath volatile hydrocarbon concentrations in exhaled air of hemodialysis patients. We assessed both C₂–C₅ alkanes – among them ethane and pentane the production of which in man is essentially due to the action free radicals exert on polyunsaturated fatty acids – and isoprene, an unsaturated hydrocarbon the biosynthesis and biological effects of which are the subject of controversy and mounting interest. Twenty patients were studied. Evaluation was performed intrapatient in the breath of patients with chronic renal failure, before and after dialysis (20 patients) and, in the same cases, during hemodialytic treatment (10 patients). Breath concentrations of these volatile hydrocarbons, determined before dialysis, were not different from those of normal subjects. Dialysis did not modify the levels of the C₂–C₅ saturated hydrocarbons ethane, propane, butane and pentane. Instead, there was a marked increase in isoprene in all patients (basal values rose by a mean of 270%). Since isoprene was not present in the fluids or filters used for dialysis and there were only traces in the ambient air, the isoprene must have been produced endogenously during hemodialysis. As no situation has previously been reported to increase endogenous production of isoprene in humans, patients in hemodialysis offer a unique opportunity to investigate in depth the medical, biological and toxicological aspects of isoprene.

Circadian blood pressure (BP) rhythm was prospectively studied by ambulatory 24-h monitoring in normotensive (n = 27) and hypertensive (n = 41) patients with stable progression of chronic renal insufficiency, and in matched control groups (healthy subjects: n = 28 and patients with essential hypertension: n = 47) without renal disease. The follow-up period lasted 24 months. The renal patients showed a disturbance in the 24-h profile of BP, with significantly blunted nocturnal pressure reduction as compared with the respective control groups (p < 0.01 and p < 0.001, respectively). In addition to the rearrangement of circadian rhythm, the normotensive and hypertensive renal patients displayed a wider distribution of systolic and diastolic BP values and a greater nocturnal variability. Among the normotensive and hypertensive patients with chronic renal insufficiency, a significant correlation was found between the decline in creatinine clearance over the 24-month period and the average nighttime diastolic BP (r = 0.526; p < 0.01 and r = 0.613; p = 0.001, respectively) and nocturnal diastolic fall (r = 0.612; p < 0.001 and r = 0.496; p < 0.01, respectively). These data offer support for the view that renal normotensive patients are exposed to a relative hypertension at nighttime and that renal hypertensive subjects can be underestimated in their hypertensive status if the measurement of BP is confined to daytime. In both groups, nocturnal BP overload can accelerate the progression rate of renal insufficiency.