Changes in Central Hemodynamics in Women With Hypertensive Pregnancy Between Before and After Delivery

Arterial function in hypertensive pregnant women. Is arterial stiffness a marker for the outcomes in pregnancy?

AIMS

Hypertension (HTN) in pregnancy is a major cause of maternal, foetal and neonatal morbimortality in both developing and developed countries. Arterial stiffness is a predictor of cardiovascular events and can be assessed through augmentation index (AIx) and pulse wave velocity (PWV). This study was intended to analyse the arterial stiffness in three categories, hypertensive pregnant women vs. healthy women (both pregnant and non-pregnant).

MAIN METHODS

Between 2018 and 2019, 150 women were prospectively included into three homogenous groups, of equal sizes (N = 50): pregnant women with HTN (group 1), pregnant women without HTN (group 2), and non-pregnant women (group 3). We assessed pregnant women 3 times (in all three trimesters) and six weeks postpartum, and the women from the control group once.

KEY FINDINGS

Significant differences (p < 0.001) of the hemodynamic and arterial stiffness parameters and of the heart rate (HR) (p = 0.006) were observed between groups 1 and 2. Women with pregnancy-induced HTN had different values of arterial function parameters long time before the first signs of high blood pressure (BP) occurred. Also, body mass index (BMI) had a deleterious effect in all patients, but especially in pregnant HTN women. Significant differences (p < 0.001) between groups 2 and 3 were observed regarding the BP and aortic PWV (PWVao) and, as well, significant differences (p < 0.05) between BMI, aortic systolic BP (p = 0.02), brachial AIx (p = 0.01) and pulse pressure (PP) (p = 0.049) values.

SIGNIFICANCE

The current study emphasizes the importance of the assessment of arterial function parameters and BMI as markers for future BP values and outcomes throughout gestation.

Effect of white-coat hypertension on arterial stiffness: A meta-analysis

BACKGROUND

White-coat hypertension (WCH) is a debatable risk factor of cardio-cerebrovascular diseases and the current study results on the association between WCH and arterial stiffness are inconsistent. The aim was to investigate the effect of WCH on arterial stiffness using meta-analysis.

METHODS

Based on prespecified search strategies and inclusion criteria, Medline, Embase, Web Of Science, Cochrane Library, and BioSciences Information Service Preview databases were reviewed. A total of 20 studies involving 1538 WCH patients and 3582 normotensives (NT) were included. Literatures were screened for data extraction and quality assessment. Overall analysis and subgroup analysis were conducted in RevMan version 5.3 and Stata version 14.0 software.

RESULTS

Overall analysis showed that carotid-femoral pulse wave velocity (cf-PWV) was significantly higher in WCH group than in the NT group (P < .00001, 95% CI: 0.79-3.26). Subgroup analysis showed that in adults, cf-PWV was significantly higher in the WCH patients than in the NT subjects (P<.001, 95% CI: 0.46-0.87), while in juveniles, cf-PWV was comparable between the WCH group and the NT group (P = .25, 95% CI: -0.39 to 0.61).

CONCLUSION

This meta-analysis showed that WCH may increase arterial stiffness in adult population.