Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in women of childbearing age: risks versus benefits

Pucci, Mark; Sarween, Nadia; Knox, Ellen; Lipkin, Graham; Martin, Una

doi:10.1586/17512433.2015.1005074

Cited by 50 publications

(18 citation statements)

References 49 publications

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“…Drug development for preeclampsia is one of the least funded areas of research,78 in part because therapeutic agents that may be beneficial to the mother79, 80 may pose harmful risks to the fetus 25, 49. Thus, it is imperative that any potential therapy guarantee that fetal exposure to the drug be minimized and that fetal health is not endangered by maternal therapy.…”

Section: Discussionmentioning

confidence: 99%

A Maternally Sequestered, Biopolymer‐Stabilized Vascular Endothelial Growth Factor (VEGF) Chimera for Treatment of Preeclampsia

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Mahdi

Chapman

et al. 2017

JAHA

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BackgroundPreeclampsia is a hypertensive syndrome that complicates 3% to 5% of pregnancies in the United States. Preeclampsia originates from an improperly vascularized and ischemic placenta that releases factors that drive systemic pathophysiology. One of these factors, soluble fms‐like tyrosine kinase‐1, is believed to sequester vascular endothelial growth factor (VEGF), leading to systemic endothelial dysfunction and hypertension. With the goal of targeting soluble fms‐like tyrosine kinase‐1 while simultaneously preventing fetal exposure to VEGF, we fused VEGF to elastin‐like polypeptide, a biopolymer carrier that does not cross the placental barrier (ELP‐VEGF).Methods and Results ELP‐VEGF restored in vitro endothelial cell tube formation in the presence of plasma from placental ischemic rats. Long‐term administered ELP‐VEGF in pregnant rats accumulated in maternal kidneys, aorta, liver, and placenta, but the protein was undetectable in the pups when administered at therapeutic doses in dams. Long‐term administration of ELP‐VEGF in a placental ischemia rat model achieved dose‐dependent attenuation of hypertension, with blood pressure equal to sham controls at a dose of 5 mg/kg per day. ELP‐VEGF infusion increased total plasma soluble fms‐like tyrosine kinase‐1 levels but dramatically reduced free plasma soluble fms‐like tyrosine kinase‐1 and induced urinary excretion of nitrate/nitrite, indicating enhanced renal nitric oxide signaling. ELP‐VEGF at up to 5 mg/kg per day had no deleterious effect on maternal or fetal body weight. However, dose‐dependent adverse events were observed, including ascites production and neovascular tissue encapsulation around the minipump.Conclusions ELP‐VEGF has the potential to treat the preeclampsia maternal syndrome, but careful dosing and optimization of the delivery route are necessary.

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Section: Discussionmentioning

confidence: 99%

A Maternally Sequestered, Biopolymer‐Stabilized Vascular Endothelial Growth Factor (VEGF) Chimera for Treatment of Preeclampsia

Logue

Mahdi

Chapman

et al. 2017

JAHA

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“…77,78 Importantly, angiotensin receptor blockers and angiotensin-converting-enzyme inhibitors should be stopped during pregnancy because of significant fetal risks. 80,81 Monitoring of plasma electrolyte levels is advised during labor. After delivery, the treatment of the mother may return to baseline supplementation and follow-up.…”

Section: Management and Follow-upmentioning

confidence: 99%

Gitelman syndrome: consensus and guidance from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Blanchard

Böckenhauer

Bolignano

et al. 2017

Kidney International

274

346

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Gitelman syndrome (GS) is a rare, salt-losing tubulopathy characterized by hypokalemic metabolic alkalosis with hypomagnesemia and hypocalciuria. The disease is recessively inherited, caused by inactivating mutations in the SLC12A3 gene that encodes the thiazide-sensitive sodium-chloride cotransporter (NCC). GS is usually detected during adolescence or adulthood, either fortuitously or in association with mild or nonspecific symptoms or both. The disease is characterized by high phenotypic variability and a significant reduction in the quality of life, and it may be associated with severe manifestations. GS is usually managed by a liberal salt intake together with oral magnesium and potassium supplements. A general problem in rare diseases is the lack of high quality evidence to inform diagnosis, prognosis, and management. We report here on the current state of knowledge related to the diagnostic evaluation, follow-up, management, and treatment of GS; identify knowledge gaps; and propose a research agenda to substantiate a number of issues related to GS. This expert consensus statement aims to establish an initial framework to enable clinical auditing and thus improve quality control of care.

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“…Studying the effect of ACEI and ARB exposure in early pregnancy proved that these classes of medication are associated with increased rates of miscarriages. The higher rate of spontaneous abortion was also observed for the other antihypertensives, showing a non-specific effect of the treatment in combination with the underlying disease [65][66][67].…”

Section: Antihypertensive Drugsmentioning

confidence: 89%

“…The most used drugs for the treatment of hypertension are angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), which are also used for the treatment of chronic kidney disease (CKD) and heart failure. Exposure to this medication in the second and third trimesters of pregnancy is known to be harmful for the fetus [65].…”

Section: Antihypertensive Drugsmentioning

confidence: 99%

See 1 more Smart Citation

The Chemical Pregnancy

Dumitrașcu¹,

Iliescu²,

Petca³

et al. 2019

Rev.Chim.

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The chemical pregnancy is an early pregnancy loss occurring shortly after implantation. 50-75% of all miscarriages are considered to be chemical pregnancies. Although the pregnancy test is positive, the fetus cannot be detected on ultrasounds; it can be asymptomatic or it can have menstrual-like cramping and bleeding. There are numerous risk factors associated with miscarriage, such as: epidemiological, genetic, anatomical, endometrial, endocrine and immune factors, infections, inherited thrombophilia and antiphospholipid syndrome. Many drugs are related with spontaneous miscarriage, significant evidence being found for nonsteroidal anti-inflammatory drugs, inhaled corticosteroids, antidepressant medication, antiepileptic and antihypertensive drugs, the artemisinin-based combination therapy and for the diclofenac/misoprostol combination. Besides the common diseases like asthma, chronic hypertension, chronic kidney disease, thyroid disorders, diabetes mellitus, polycystic ovary syndrome and rheumatoid arthritis, there was also found a higher correlation with the risk of miscarriage for the Zika Virus infection. In conclusion, chemical pregnancy is a type of early pregnancy loss which usually doesn�t need prevention, associated with multiple risk factors.

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Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in women of childbearing age: risks versus benefits

Cited by 50 publications

References 49 publications

A Maternally Sequestered, Biopolymer‐Stabilized Vascular Endothelial Growth Factor (VEGF) Chimera for Treatment of Preeclampsia

A Maternally Sequestered, Biopolymer‐Stabilized Vascular Endothelial Growth Factor (VEGF) Chimera for Treatment of Preeclampsia

Gitelman syndrome: consensus and guidance from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

The Chemical Pregnancy

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