Preeclampsia y enfermedad cardiovascular: un enfoque integral para detectar las fases subclínicas de complicaciones obstétricas y cardiovasculares / Preeclampsia and cardiovascular disease: an integrated approach to detect the subclinical stages of obstetrical and cardiovascular complications

Desde 1995 hasta la fecha la asociación entre patologías derivadas los embarazos hipertensivos y las enfermedades cardiovasculares ha generado un gran volumen de potentes evidencias epidemiológicas y clínicas. Los propósitos de esta revisión son varios. Mostrar la consistencia y magnitud de la evidencia científica. Integrar los riesgos/enfermedades cardiovasculares y los problemas obstétricos a través de la disfunción endotelial. Preconizar el seguimiento postparto de la hipertensa embarazada, como una ventana de oportunidad para beneficiar la salud de las mujeres y sus hijos. Incluir la historia obstétrica como factor de riesgo de enfermedad coronaria. Proponer cuestionarios adaptables a las prácticas locales para facilitar la pronta incorporación de los índices de riesgo obstétrico y cardiovascular en dos etapas de la vida de una mujer. Ha llegado el momento para que los equipos obstétricos, cardiológicos y las pacientes jueguen un rol en la prevención de los riesgos y enfermedades cardiovasculares.

From 1995 onwards the association between hypertensive pregnancies and cardiovascular disease has generated a great volume of epidemiologic and clinical evidence. The purposes of this review are several. To demonstrate the consistence and weight of the scientific evidence. To integrate cardiovascular risks/diseases and obstetric complications through the link of endothelial dysfunction. To advocate postpartum follow-up after a hypertensive pregnancy as a window of opportunity to benefit the health of mothers and offsprings. To include the obstetrical history as a risk factor for coronary disease. To propose questionnaires adaptable to local practices to incorporate cardiovascular and obstetrical indexes in two stages of a woman's lifetime. The time has come for obstetrical teams, cardiologists and patients to play a preventive role regarding cardiovascular risks and diseases.

Preeclampsia y enfermedad cardiovascular: un enfoque integral para detectar las fases subclínicas de complicaciones obstétricas y cardiovasculares / Pregnancy and cardiovascular disease: a comprehensive approach to detect subclinical phases of obstetric and cardiovascular complications

ANTECEDENTES: Desde 1995 hasta la fecha la asociación entre patologías derivadas los embarazos hipertensivos y las enfermedades cardiovasculares ha generado un gran volumen de potentes evidencias epidemiológicas y clínicas. OBJETIVOS: Los propósitos de esta revisión son varios. Mostrar la consistencia y magnitud de la evidencia científica. Integrar los riesgos/enfermedades cardiovasculares y los problemas obstétricos a través de la disfunción endotelial. Preconizar el seguimiento postparto de la hipertensa embarazada, como una ventana de oportunidad para beneficiar la salud de las mujeres y sus hijos. Incluir la historia obstétrica como factor de riesgo de enfermedad coronaria. Proponer cuestionarios adaptables a las prácticas locales para facilitar la pronta incorporación de los índices de riesgo obstétrico y cardiovascular en dos etapas de la vida de una mujer. CONCLUSIÓN: Ha llegado el momento para que los equipos obstétricos, cardiológicos y pacientes jueguen un rol en la prevención de los riesgos y enfermedades cardiovasculares.

BACKGROUND: From 1995 onwards the association between hypertensive pregnancies and cardiovascular disease has generated a great volume of epidemiologic and clinical evidence. OBJECTIVES: The purposes of this review are several. To demonstrate the consistence and weight of the scientific evidence. To integrate cardiovascular risks/ diseases and obstetric complications through the link of endothelial dysfunction. To advocate postpartum follow-up after a hypertensive pregnancy as a window of opportunity to benefit the health of mothers and offsprings. To include the obstetrical history as a risk factor for coronary disease. To propose questionnaires adaptable to local practices to incorporate cardiovascular and obstetrical indexes into two stages of a woman's lifetime. CONCLUSION: The time has come for obstetrical teams, cardiologists and patients to play a preventive role regarding cardiovascular risks and diseases.

Comparison of C-reactive proteins level in gestational hypertension and in normal pregnancy in 2nd and 3rd trimester and its correlation with maternal and foetal outcome

Background: Hypertensive pregnancy disorder covers a spectrum of clinical conditions namely preeclampsia, eclampsia, chronic hypertension and gestational hypertension. Impaired function of vascular endothelium in preeclampsia may cause abnormal immune activation causing release of inflammatory agents like cytokines, C-reactive proteins (CRP) etc. Aim of this study is to evaluate the CRP (Q) levels in gestational hypertension and in normal pregnancy in 2nd and 3rd trimester and its correlation with maternal and foetal outcome.Methods: Total 350 patients were involved in the study with 160 subjects in Study group meeting the eligibility criteria and 190 subjects in control group. All the cases were followed up during the rest part of their antenatal, labour and postpartum period for development of preeclampsia and eclampsia and their effect on mother and foetus.Results: In 2nd and 3rd trimester mean CRP level in study group was 10.01 mg/L and 10.28 mg/L compare to control group 1.85 mg/L and 3.06 mg/L respectively. Difference of mean CRP level was statistically significant (P value <0.001) in both 2nd and 3rd trimester. Gestational age at delivery and birth weight, Apgar score for baby was lower in study group as compared to control group. Maternal morbidity, maternal mortality, mode of delivery by caesarean section, IUD, still birth, preterm delivery, IUGR, baby with respiratory distress syndrome was significantly higher in study group.Conclusions: Increased serum CRP level can be used as a biomarker for identifying women at risk of preeclampsia and its complications along with adverse effect.

Cardiac Myeloperoxidase Activity Is Elevated in Hypertensive Pregnant Rats / 华中科技大学学报（医学）（英德文版）

Myeloperoxidase (MPO) is released from activated neutrophils.The inflammation in preeclampsia was found to be associated with endothelial dysfunction.We hypothesized that cardiac and circulating MPO levels are elevated in hypertensive pregnancy.Systolic and diastolic blood pressure and heart rate were measured on pregnancy days 14,16,18 and 20 in normal pregnant and hypertensive pregnant rats.Left and right ventricle weights,the number of viable fetuses,litter size,fetal and placenta weights were recorded on gestational day 21.Circulating and cardiac MPO activities,soluble fms-like tyrosine kinase-1 (sFlt-1) and vascular endothelial growth factor (VEGF) and nitric oxide (NO) were detected.The results showed increases in cardiac (left,but not right ventricle) and circulating MPO activities,and concomitantly lower number of viable fetuses,litter size,and fetal and placenta weights,and decreases in NO in hypertensive pregnant rats.Also,the increases in circulating sFlt-1 and VEGF were found in hypertensive pregnant group.In conclusion,maternal and fetal detrimental changes along with increases in circulating sFlt-1 and VEGF in hypertensive pregnancy may be associated with increases in cardiac and circulating MPO activities,confirming the causative role of inflammatory response in preeclampsia.

Factores clínicos y bioquímicos de riesgo de hipertensión arterial en mujeres con diagnóstico previo de estados hipertensivos del embarazo / Clinical and biochemical risk factors for hypertension in women with previous diagnosis of hypertensive states of pregnancy

Resumen: OBJETIVO: determinar la incidencia, a largo plazo, de hipertensión arterial en mujeres con diagnóstico previo de estados hipertensivos del embarazo e identificar los factores clínicos y bioquímicos gestacionales que incrementan el riesgo posterior de padecer hipertensión. MATERIALES Y MÉTODOS: estudio de casos y controles anidados en una cohorte. Se estudiaron las pacientes en quienes se estableció el diagnóstico de estados hipertensivos del embarazo entre 2000 y 2010. Grupo 1: mujeres con diagnóstico de estados hipertensivos del embarazo y posterior inicio de hipertensión arterial. Grupo 2: control de mujeres con diagnóstico de estados hipertensivos del embarazo que durante el tiempo de seguimiento no padecieron hipertensión arterial. Para determinar la potencial asociación entre las variables de estudio con la hipertensión arterial posterior se realizaron pruebas paramétricas y no paramétricas, y para detectar la relación o interacción entre las diferentes variables se estudiaron sus correlaciones. RESULTADOS: se registraron 121 pacientes con estados hipertensivos del embarazo. La incidencia posterior de hipertensión arterial fue de 41.3%. El tiempo promedio transcurrido hasta el diagnóstico de hipertensión arterial fue de 11.7 años (IC 95%: 10.6-12.9). El único factor de riesgo de hipertensión arterial posterior a la gestación índice fue la multiparidad. Ninguno de los demás parámetros estudiados tuvo significación estadística. CONCLUSIONES: los estados hipertensivos del embarazo son un factor de riesgo para el posterior desarrollo de hipertensión arterial. No es posible determinar, con base en los parámetros clínicos o bioquímicos gestacionales, cuáles presentarán una mayor incidencia de hipertensión futura. Todas las gestantes con esta patología deben ser informadas del riesgo hipertensivo a largo plazo.

Abstract: OBJECTIVE: To determine the incidence of long-term hypertension in women who were previously diagnosed of hypertensive pregnancy states. Secondarily identify clinical and biochemical gestational factors that increase the subsequent risk of hypertension. MATERIAL AND METHODS: Study of nested cases and controls in a cohort. Patients were selected who were diagnosed of "hypertensive pregnancy disorders" between 2000 and 2010 and two subgroups were differentiated: Group cases: women diagnosed with "hypertensive pregnancy disorders" and subsequent development of hypertension. - Control group: women with the diagnosis of "hypertensive pregnancy disorders" and who at the time of follow-up did not develop hypertension. The mean time elapsed until the diagnosis of hypertension was 11.79 years (95% CI: 10.6-12.90). Parametric and non-parametric tests were performed to determine the Potential association between the study variables with the later hypertension. In addition, to detect the relationship or interaction between the different variables, their correlations were studied. The influence of the different gestational variables on the subsequent occurrence of arterial hypertension as a function of the time parameter was obtained through the Kaplan Meier survival study and the COX models were applied for the categorical variables. RESULTS: We studied 121 patients diagnosed with "hypertensive pregnancy disorders". The subsequent incidence of hypertension was 41.32%. As a risk factor for posterior hypertension in gestation index, only multiparity was identified. None of the other parameters studied presented statistical significance. CONCLUSIONS: The hypertensive pregnancy disorders are a risk factor for the subsequent development of hypertension. It is not possible to determine, based on clinical or biochemical gestational parameters, which will present a higher incidence of future hypertension. All pregnant women with this pathology should be informed of the long-term hypertensive risk.