Hemodynamic and neurohumoral profile in patients with different types of hypertension in pregnancy

Abstract

Hypertension in pregnancy is a frequent disorder that includes a spectrum of conditions. We aimed at comparatively evaluating the hemodynamic, echocardiographic and biohumoral profile of a sample of pregnant Caucasian women with different form of pregnancy-related hypertension. We enrolled 39 non-hypertensive pregnant women (NP), 26 with Chronic HBP in pregnancy (CH), 24 with gestational hypertension (G-PIH), and 33 with pre-eclampsia. We recorded and compared blood pressure (BP), echocardiographic parameters, resting plasma renin activity (PRA) and plasma aldosterone (PA), Plasma levels of atrial (ANP) and brain natriuretic peptide (BNP). PE patients had a significantly higher BP than either G-PIH or NP patients. PE patients had also significantly lower cardiac output than NP, G-PIH and CH. In comparison to NP patients, the total peripheral vascular resistance was 61% higher in PE women and 38% higher in CH patients. All echographic parameters were significantly more altered in PE patients when compared with NP, in respect to any other form of hypertension. Either ANP (+35%) and BNP (+40%) were significantly higher in PE patients than in controls. The PRA was reduced in PE and CH patients when compared either with NP (-38 and -35%, respectively) or G-PIH (-47 and -43%, respectively). On the basis of our data, we can conclude that PE is the gestation associated hypertension with the largest anatomical, functional and biohumoral involvement, and so it has to be involved in a more intensive monitoring and evaluation.

Obstetric Nephrology

“…In nondiabetic women, increased levels of ANP and brain natriuretic peptide are seen in late pregnancy when the diagnosis of pre-eclampsia has been established (39,40). In a small, prospective series of women with type 1 diabetes followed throughout pregnancy at our center, pre-eclampsia developed in six women (7%) with significantly higher ANP levels at 9 gestational weeks compared with women not developing pre-eclampsia.…”

Cardiovascular Implications in Preeclampsia

“…This is consistent with remodeling patterns seen in early hypertension without evidence of age or ethnic specificity in the women evaluated so far. 30 Although several other studies have also demonstrated LV dysfunction, [41][42][43][44][45][46][47][48] increased aortic stiffness, [49][50][51] and reduced venous capacity in preeclampsia, 52 it remains difficult to truly understand by noninvasive methods whether decreased LV performance with preeclampsia affected myocardial contractility. Indeed, each echocardiographic index is only a surrogate of the true myocardial state, and it is invariably affected by loading conditions, heart rate, and cardiac geometry in a lesser or greater extent.…”

Salt Intake, Home Blood Pressure, and Perinatal Outcome in Pregnant Women

“…It has been shown that hemodynamic profile differs with the type of hypertension in pregnancy. 33 Hemodynamic assessment will need to be included in further studies with a larger sample size.…”