Hypertension in pregnancy

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Abstract

Normal pregnancy is characterized by a marked reduction in peripheral vascular resistance. Blood pressure is diminished, while cardiac output, blood volume, renal blood flow and the glomerular filtration rate are increased. These hemodynamic changes are reversed in preeclampsia-eclampsia (PE-E), a condition considered to be related to a dysfunction of the endothelium. Decreases in the production of nitric oxide (NO)and prostacyclin (in association with an increased synthesis of thromboxane A2) may play a role in the pathogenesis of PE-E. Recent reports have supported the concept that an imbalance between vasodilators and vasoconstrictors may explain the clinical, laboratory and hemodynamic disturbances observed in PE-E. Particular attention has been given to the fact that a state of L-arginine NO deficiency may be present. The controlof hypertension, rest, and close clinical and laboratory surveillance remain the gold standard to minimize the severity ofthe complications of PE-E. However, on the basis of its physiology and pathophys-iology, low-dose aspirin has been recommended in pregnancies at risk to prevent or, at least, to delaythe occurrence of PE-E. Although initial reports showed promising results, recent conclusions from large trials have moderated this optimism. The use of supplemental L-arginine may beconsidered another possibility of treatment, and experimenta data have given convincing results, but there are no reports on PE-E. Therefore, the practical management of PE-E requiresprudence, careful follow-up and prompt decisions on the precise moment for delivery (which remains the most effective therapeutic procedure).

Original languageEnglish
Pages (from-to)254-263
Number of pages10
JournalNephron
Volume76
Issue number3
DOIs
StatePublished - 1997

Keywords

  • Endothelial cells
  • Hypertension
  • Physiology-pathophysiology
  • Preeclampsia
  • Pregnancy
  • Pregnancy

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