Trastornos hipertensivos en el embarazo: repercusión a largo plazo en la salud cardiovascular de la mujer

Álvarez-Álvarez, Beatriz; Martell-Clarós, Nieves; Abad-Cardiel, M.; García-Donaire, José Antonio

doi:10.1016/j.hipert.2016.06.002

Cited by 21 publications

(12 citation statements)

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“…There may be a need for an extension of the time frame defining puerperium and follow-up of these women to reduce the proportion of women lost to follow-up. Women with a prior history of PE has been found to have a 2-fold increase in the risk of stroke, arrhythmias, and heart failure, and 10-fold increase in the risk of developing chronic kidney disease; and clinic visits in the postpartum period has being identified as a great opportunity to screen and identify those with chronic hypertension 3. Postpartum screening of cardiovascular risk factor and subsequent treatment in women with a history of PIH or PE at term was found to be cost-effective in a previous study17 and this should, thus, be encouraged.…”

Section: Discussionmentioning

confidence: 99%

“…Hypertensive disorders in pregnancy are a major contributor to maternal deaths worldwide, responsible for 5%–15.5% of maternal deaths 12. It has been reported that women with pregnancy-induced hypertension (PIH), whether proteinuric or nonproteinuric, are at risk of cardiovascular diseases later in life, such as essential hypertension, ischemic heart disease, and thromboembolic disease 34. Up to one-third of women with hypertensive disorders in pregnancy may develop hypertension within a decade of an affected pregnancy56 and up to 1 in 5 of these women will be hypertensive 15 years postpartum 7.…”

Section: Introductionmentioning

confidence: 99%

“…Hypertensive disorders in pregnancy may also predispose to a number of noncardiovascular events in the long-term and these include Type 2 diabetes mellitus and chronic kidney disease 38910. In a recent study, it was found that women with a history of the hypertensive disease in pregnancy are four times more likely to develop posttraumatic stress disorders 11.…”

Section: Introductionmentioning

confidence: 99%

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Postpartum sequelae of the hypertensive diseases of pregnancy: A pilot study

2018

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Background: Hypertensive disorders are one of the most common medical conditions that may complicate pregnancy. Postpartum blood pressure (BP) pattern is, however, less clear in affected women and decision to discharge them is usually decided arbitrarily. Materials and Methods: A cohort study conducted at Lagos University Teaching Hospital, Lagos, Nigeria, aimed at determining the proportion of pregnant women with pregnancy-induced hypertension (PIH) and preeclampsia (PE) whose BP remains elevated 6 weeks postdelivery and factors associated with the persistent rise. Fifteen women each with PIH and PE were studied in different phases of pregnancy and followed up until 6 weeks postdelivery. Fifteen normotensive pregnant women served as controls. BP patterns were monitored and fasting lipid levels, serum creatinine, fasting glucose profile (FGP), and FGP/insulin ratio were assayed. Data were analyzed with IBM SPSS version 20. Results: Proportion of women with PIH or PE who had persistent hypertension at 6 weeks postpartum was 3/29 (10.3%), risk ratio of 1.1. No statistically significant association was found between mean arterial BP at 6 weeks postpartum and age, parity, gestational age at delivery, body mass index, and family history of hypertension. Serum creatinine level showed moderate correlation with persistent hypertension at 6 weeks postpartum ( r = 0.441,P = 0.006), with sensitivity of 100% and specificity of 81.8% at cutoff value of 1.2 mg/dL in detecting pregnant women with hypertensive disorders who will likely remain hypertensive at 6 weeks postpartum. Conclusion: There is a need for long-term follow-up of women with PIH/PE beyond puerperium.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Postpartum sequelae of the hypertensive diseases of pregnancy: A pilot study

2018

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“…Otherwise healthy women who develop preeclampsia during pregnancy are at a significantly (2–7 times) greater risk for the development of CVD 3 , and develop primary hypertension at a younger age, and with greater frequency than women who have healthy pregnancies 4–7 . Furthermore, women who have had preeclampsia are significantly more likely to die of CVD 8–10 , and represent an important at-risk cohort that require early mechanism-specific intervention strategies to prevent or mitigate CVD morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Increased Angiotensin II Sensitivity Contributes to Microvascular Dysfunction in Women Who Have Had Preeclampsia

et al. 2017

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Women who have had preeclampsia have increased CVD risk, however the mechanism(s) responsible for this association remain unclear. Microvascular damage sustained during a preeclamptic pregnancy may persist post-partum. The putative mechanisms mediating this dysfunction include a reduction in nitric oxide (NO)-dependent dilation, and an increased sensitivity to angiotensin II (ang II). In this study, we evaluated endothelium-dependent dilation, ang II sensitivity, and the therapeutic effect of ang II receptor blockade (losartan) on endothelium-dependent dilation in vivo in the microvasculature of women with a history of preeclampsia (PrEC, n=12) and control women who had a healthy pregnancy (HC, n=12). We hypothesized that PrEC would have 1) reduced endothelium-dependent dilation, 2) reduced NO-mediated dilation, and 3) increased sensitivity to ang II. We further hypothesized that localized losartan would increase endothelium-dependent vasodilation in PrEC. We assessed microvascular endothelium-dependent vasodilator function by measurement of cutaneous vascular conductance responses to graded infusion of acetylcholine (ACh; 10−7–102mmol/L) and a standardized local heating protocol in control sites and sites treated with 15mmol/L L-NAME (NO-synthase inhibitor) or 43μmol/L losartan. Further, we assessed microvascular vasoconstrictor sensitivity to ang II (10−20–10−4mol/L). PrEC had significantly reduced endothelium-dependent dilation (−0.3±0.5 vs −1.0±0.4 logEC50; P<0.001) and NO-dependent dilation (16±3 vs 39±6%; P=0.006). PrEC also had augmented vasoconstrictor sensitivity to ang II (−10.2±1.3 vs −8.3±0.5; P=0.006). AT1R-inhibition augmented endothelium-dependent vasodilation and NO-dependent dilation in PrEC but had no effect in HC. These data suggest that women who have had preeclampsia have persistent microvascular dysfunction post-partum, mediated in part by increased sensitivity to ang II.

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“…Dodatkowo u tych pacjentek zaobserwowano dziesięciokrotnie wyższe ryzyko rozwinięcia się chorób nerek. Uważa się, iż okres poporodowy w tej grupie kobiet jest bardzo dobrą okazją do modyfi kacji zwyczajów związanych z trybem życia, nadwagą/otyło-ścią, wczesnej diagnostyki przewlekłego nadciśnienia tętniczego, cukrzycy i interwencji w celu zmniejszenia zapadalności na choroby układu sercowo-naczyniowego [8,9].…”

Section: Etiopatogeneza Nadciśnienia Indukowanego Ciążąunclassified

Diagnostyka i leczenie nadciśnienia indukowanego ciążą jako element profilaktyki okołoporodowej

Hajduk¹,

Michalik²,

Olszewska³

et al. 2017

Piel Pol

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STRESZCZENIENadciśnienie indukowane ciążą (NIC) jest jedną z najczęstszych patologii okresu okołoporodowego oraz jedną z głównych przyczyn umieralności matek, płodów oraz noworodków. Częstość występowania NIC ocenia się na 3-10% ciężarnych, a u 15-25% tej grupy rozwija się stan przedrzucawkowy. Oszacowano, iż 18% zgonów wśród ciężarnych i położnic wiąże się z NIC i jego powikłaniami, zwłaszcza z rozsianym wykrzepianiem wewnątrz-naczyniowym (DIC) [1]. Dodatkowo NIC wiąże się ze zwiększonym ryzykiem powikłań perinatologicznych: porodem przedwczesnym i niską masą urodzeniową. Powikłania te mają długoterminowe skutki dla dziecka i rodziny. NIC jest to stan podwyższonego ciśnienia tętniczego (powyżej 140/90 mmHg), pojawiający się de novo po 20. tygodniu ciąży (t.c.) i ustępujący po porodzie. Według klasyfi kacji z 2007 r., ustalonej przez European Society of Cardiology (ESC) i European Society of Hypertension (ESH), wyróżnia się nadciśnienie przewlekłe, nadciśnienie indukowane ciążą, stan przedrzucawkowy, zespół HELLP oraz nadciśnienie indukowane ciążą nakładające się na nadciśnienie przewlekłe. W etiologii opisywany jest współudział czynników genetycznych, środowiskowych, immunologicznych i metabolicznych. Ponieważ wieloczynnikowa patogeneza NIC oraz stanu przedrzucawkowego nie jest całkowicie poznana, pełne zapobieganie oraz przewidywanie wystąpienia choroby nie jest moż-liwe. Profi laktyka wtórna skupia się na zapobieganiu powikłaniom u matek (np.: rzucawka) oraz płodów (np.: wcześniactwo). Przebyty stan przedrzucawkowy koreluje z podwyższonymi wskaźnikami zapadalności na choroby układu sercowo-naczyniowego oraz metaboliczne w kolejnych ciążach i późniejszym okresie życia. Konieczne jest przeprowadzenie w tej grupie pacjentek edukacji na temat stylu życia oraz wdrożenia działań diagnostyczno-leczniczych [1]. Celem pracy jest przedstawienie głównych założeń w postępo-waniu diagnostycznym, edukacyjnym i leczniczym NIC oraz stanu przedrzucawkowego, co może stanowić swoiste kompendium dla praktyków i teoretyków opieki położniczej. Minimalizowanie skutków powikłań NIC, z uwagi na częstość występowania schorzenia, jest jednym z głównych założeń w profi laktyce okołoporo-dowej [4] i profi laktyce chorób układu sercowo-naczyniowego.SŁOWA KLUCZOWE: nadciśnienie indukowane ciążą, profi laktyka okołoporodowa. ABSTRACTPregnancy-induced hypertension (PIH) is one of the most common perinatal pathologies and a leading cause of maternal, fetal and neonatal mortality. Prevalence of PIH is estimated at 3-10% of all pregnancies, and 15-25% of women with this condition may eventually develop preeclampsia. Mortality of women in pregnancy and puerperium due to PIH and its complications, especially disseminated intravascular coagulation (DIC), is estimated at 18% [1]. Moreover, PIH is associated with increased risk of perinatal complications: preterm birth and low birth weight. These complications may have long-term consequences for both the children and their family members. PIH is defi ned as the development of new hypertension (arter...

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Trastornos hipertensivos en el embarazo: repercusión a largo plazo en la salud cardiovascular de la mujer

Cited by 21 publications

References 59 publications

Postpartum sequelae of the hypertensive diseases of pregnancy: A pilot study

Postpartum sequelae of the hypertensive diseases of pregnancy: A pilot study

Increased Angiotensin II Sensitivity Contributes to Microvascular Dysfunction in Women Who Have Had Preeclampsia

Diagnostyka i leczenie nadciśnienia indukowanego ciążą jako element profilaktyki okołoporodowej

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