The role of arterial hypertension in the development of cerebrovascular diseases in pregnancy

Abstract

Nowadays, the risk factors, improvement of diagnosis and treatment of cardiovascular diseases are of particular interest. Arterial hypertension (HTN) is known to contribute to cardiovascular disease and to be a risk factor for cerebrovascular diseases. HTN during pregnancy and in the postpartum period draws particular attention. Throughout the world, hypertension during pregnancy remains the leading cause of maternal and child morbidity and mortality. To our knowledge, only a few works studied neurological disorders associated with HTN in pregnant women. In this connection, the purpose of our review was to analyze the role of HTN in the development of cerebrovascular diseases in pregnancy. Pregnant women with HTN show 5,2-fold higher frequency of strokes than normotensive women. The risk of stroke increases from the third trimester of pregnancy to six weeks of the postpartum period. The pregnant women with HTN develop changes in the coagulation system leading to the formation of arterial and venous thromboses in the cerebrovascular circulation. The presence of preeclampsia (PE) is associated with the 7–9-fold increase in the risk of stroke. Endothelial dysfunction is one of the leading links in the pathogenesis of PE. The PE is associated with an increase in anti-angiogenic factors and a decrease in angiogenic factors. Thus, the measures preventing the development of cerebrovascular diseases in pregnant women with HTN, include identification of prehypertension in women of childbearing age, the improvement of HTB management strategies, and an interdisciplinary approach to the diagnostic and treatment process involving the obstetrician, the therapist, the cardiologist and the neurologist.