Reduced plasma levels of angiotensin-(1-7) and renin activity in preeclamptic patients are associated with the angiotensin I- converting enzyme deletion/deletion genotype

The relationship between preeclampsia and the renin-angiotensin system (RAS) is poorly understood. Angiotensin I-converting enzyme (ACE) is a key RAS component and plays an important role in blood pressure homeostasis by generating angiotensin II (Ang II) and inactivating the vasodilator angiotensin-(1-7) (Ang-(1-7)). ACE (I/D) polymorphism is characterized by the insertion (I) or deletion (D) of a 287-bp fragment, leading to changes in ACE activity. In the present study, ACE (I/D) polymorphism was correlated with plasma Ang-(1-7) levels and several RAS components in both preeclamptic (N = 20) and normotensive pregnant women (N = 20). The percentage of the ACE DD genotype (60 percent) in the preeclamptic group was higher than that for the control group (35 percent); however, this percentage was not statistically significant (Fisher exact test = 2.86, d.f. = 2, P = 0.260). The highest plasma ACE activity was observed in the ACE DD preeclamptic women (58.1 ± 5.06 vs 27.6 ± 3.25 nmol Hip-His Leu-1 min-1 mL-1 in DD control patients; P = 0.0005). Plasma renin activity was markedly reduced in preeclampsia (0.81 ± 0.2 vs 3.43 ± 0.8 ng Ang I mL plasma-1 h-1 in DD normotensive patients; P = 0.0012). A reduced plasma level of Ang-(1-7) was also observed in preeclamptic women (15.6 ± 1.3 vs 22.7 ± 2.5 pg/mL in the DD control group; P = 0.0146). In contrast, plasma Ang II levels were unchanged in preeclamptic patients. The selective changes in the RAS described in the present study suggest that the ACE DD genotype may be used as a marker for susceptibility to preeclampsia.

Pressao arterial media no segundo trimestre e o prognostico da gestacao de hipertensas. / Mean arterial blood pressure in the 2d trimester and the prognosis of hypertension in pregnancy

Em 41 gestantes portadoras de hipertensao cronica, correlacionou-se a medida de pressao arterial media (PAM) no segundo trimestre com as ocorrencias do periodo neonatal e com as complicacoes gestacionais apresentadas nestas pacientes. Encontrou-se uma relacao direta da PAM acima de 130 mmHg no segundo trimestre e elevada mortalidade perinatal, alta incidencia de baixo peso e prematuridade. Neste grupo de gestantes ocorreram frequentes complicacoes no pos-parto. Concluiu-se que a PAM no segundo trimestre tem grande valor no prognostico da sobrevivencia do recem-nascido de gestante hipertensa, e ainda correlacionou-se significativamente com a incidencia de complicacoes maternas no periodo pos-parto.