Autonomic Imbalance in Preeclampsia: Evidence for Increased Sympathetic Tone in Response to the Supine-Pressor Test

Lewinsky, Reuven M.; Riskin-Mashiah, Shlomit

doi:10.1016/s0029-7844(98)00105-7

Cited by 52 publications

(35 citation statements)

References 12 publications

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“…Other studies have concluded that both sympathetic and vagal responses are increased in pre-eclampsia [29]. Pre-eclamptic women have an autonomic imbalance associated with an increase in sympathetic nervous tone, increased heart rate, and hypertension as compared to normal pregnant women [30,31].…”

Section: Obstructive Sleep Apnea Associated With Endothelial Functionmentioning

confidence: 98%

Mechanism of development of pre-eclampsia linking breathing disorders to endothelial dysfunction

2009

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s u m m a r yHigh blood pressure is an important component of pre-eclampsia. The underlying mechanism of development of hypertension in pre-eclampsia is complicated and still remains obscure. Several theories have been advanced including endothelial dysfunction, uteroplacental insufficiency leading to generalized vasoconstriction, increased cardiac output, and sympathetic hyperactivity. Increased blood flow and pressure are thought to lead to capillary dilatation, which damages end-organ sites, leading to hypertension, proteinuria and edema. Additional theories have been put forward based on epidemiological research, implicating immunological and genetic factors. None of these theories have been substantiated. Based on a review of literature this paper postulates that the initiating event for the development of preeclampsia is intermittent hypoxia associated with irregular breathing during sleep, hypoapnea, apnea, inadequate respiratory excursions during the waking hours and inadequate cardiopulmonary synchronization (abnormal sympatho-vagal balance).Ó 2009 Elsevier Ltd. All rights reserved. BackgroundDespite being one of leading causes of maternal death and a major contributor of maternal and perinatal morbidity, the mechanism responsible for the pathogenesis of pre-eclampsia remains unclear [1,2]. Evidence shows that inadequate oxygenation from various causes leads to the initiation of an abnormal autonomic response. Several studies show a strong association between obstructive sleep apnea (OSA) and hypertension in the non-pregnant state [3,4]. Few studies in pregnancy corroborate this finding [5,6]. Nocturnal hypertension is observed significantly more in patients who have pre-eclampsia than those with gestational hypertension or chronic hypertension [5]. Also in OSA there is relative increase of the sympathetic activity associated with vasospasm, endothelial dysfunction, and increased angiotensin II levels, findings that are also implicated in the pathogenesis of pre-eclampsia [7,8].Incidence of snoring, hypoapnea and sleep apnea in the nonpregnant state, pregnancy and pre-eclampsiaThe incidence of snoring, hypoapnea, and sleep apnea is 9% in non-pregnant females and 14% in pregnant women [9][10][11]. By the third trimester, 24% of women were reported to have a snoring problem (symptom of sleep apnea). Habitual snorers had a higher frequency of pregnancy-induced hypertension (14%) compared to 6% of non-habitual snorers. The intrauterine growth retardation incidence was 7% in habitual snorers compared to 2.6% in nonsnorers [10]. In this study it was noted that all subjects who habitually snored and developed pre-eclampsia started to snore before hypertension or proteinuria was present. Abnormalities of breathing such as inspiratory flow limitation are observed more frequently in patients with pre-eclampsia (31 ± 8%) as compared to normal pregnant women (15.5 ± 2.3%), and non-pregnant females (<5%) [9]. The autonomic imbalance associated with this abnormal breathing was found to be associated with high systoli...

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Section: Obstructive Sleep Apnea Associated With Endothelial Functionmentioning

confidence: 98%

Mechanism of development of pre-eclampsia linking breathing disorders to endothelial dysfunction

2009

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“…This showed a pronounced increase in power in the very low-frequency range of heart rate variability, suggesting a marked increase in sympathetic tone. 172 The urinary excretion of both prostaglandin 6-keto F 1␣ and kallikrein is reduced long before clinical signs of the disease are apparent (eg, Fitzgerald et al, 1987 73 ;Millar et al, 1996 162 ; Mills et al, 1999 173 ), perhaps again reflecting early endothelial damage. There is considerable interest in the possibility of decreased endothelial NO synthesis contributing to the vasoconstriction of PE.…”

Section: The Cardiovascular Systemmentioning

confidence: 99%

Hypertension in pregnancy

Pipkin

Roberts

2000

J Hum Hypertens

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Hypertension arising during pregnancy remains one of the two most frequently-cited causes of maternal death in the UK. In some cases, pregnancy is unmasking underlying hypertension, which manifests itself in later life. Pregnant women who develop de novo proteinuric hypertension (pre-eclampsia, PE) can share many risk factors with patients with the metabolic syndrome, such as obesity, dyslipidaemia and insulin resistance. However, more than half the women who develop PE remain normotensive thereafter. There is a genetic component(s) to the disease, but it is most improbable that there is a 'PE gene'. Rather, there are factors such as geneticallydetermined thrombophilias which are predisposers but not prerequisites. Impaired placentation is a feature, with inadequate invasion of the spiral arteries by syncytiotrophoblast and poor remodelling. However, similiar features are found in association with non-hypertensive

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“…63 Women who develop severe preeclampsia, especially early-onset, have a higher rate of deaths attributable to CVD as well as an increased risk of having family members who have had early-onset CVD of any type. 15,21,54,62 Although this study was small, specifically preventing us from exploring the relationship and statistical significance of first-and second-generational FH for HTN, MI, and stroke, we were able to identify several known physiologic clinical precursors to both preeclampsia and ischemic CVD, supporting the hypothesis that there is a nonpregnancy phenotype that exists in young women who have an FH of these cardiovascular events. This phenotype likely contributes to the ''pregnancy as a stress-test'' hypothesis, whereby preeclampsia unmasks preexisting physiologic characteristics that predispose to preeclampsia and future CVD risk.…”

Section: Discussionmentioning

confidence: 56%

The Relationship of a Family History for Hypertension, Myocardial Infarction, or Stroke With Cardiovascular Physiology in Young Women

et al. 2014

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Cardiovascular disease (CVD) and preeclampsia share several pathophysiologic risk factors. We examined family history (FH) and physiologic status in 60 healthy, nulliparous women to determine the relationship between FH and known risk factors for CVD. Data are presented as mean + standard error (SE). Decreased uterine blood flow was observed in women with FH of hypertension (þFH: 21.5 + 1.7, no FH: 33.3 + 9.0 mL/min; P ¼ .04). Women reporting an FH of stroke showed increased alpha-and beta-adrenergic response, as measured by Valsalva maneuver (a: FH: 24.7 + 1.9, ÀFH: 18.9 + 1.1 mm Hg, P ¼ .02; b: FH: 22.0 + 2.1, ÀFH: 16.9 + 1.4 mm Hg; P ¼ .04), and increased cardiac output (4.83 + 0.22 vs 4.31 + 0.12 L/min; P ¼ .01). We identified no significant physiologic associations linked to an FH of myocardial infarction. Our observations show significant differences in physiologic characteristics in women with specific CVD family histories. These data, coupled with known heritable contributions to CVD and preeclampsia, suggest a distinct physiologic phenotype that may link preeclampsia risk with FH of CVD, independent of pregnancy.

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Autonomic Imbalance in Preeclampsia: Evidence for Increased Sympathetic Tone in Response to the Supine-Pressor Test

Cited by 52 publications

References 12 publications

Mechanism of development of pre-eclampsia linking breathing disorders to endothelial dysfunction

Mechanism of development of pre-eclampsia linking breathing disorders to endothelial dysfunction

Hypertension in pregnancy

The Relationship of a Family History for Hypertension, Myocardial Infarction, or Stroke With Cardiovascular Physiology in Young Women

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