title: Hemodynamically-directed atenolol therapy is associated with a blunted rise in maternal sFLT-1 levels during pregnancy.
abstract: OBJECTIVE
  Cardiac output and sFlt-1 are elevated prior to clinical evidence of preeclampsia. Early treatment of high cardiac output with atenolol decreases the risk for preeclampsia. We hypothesized that atenolol would impact circulating sFlt-1.
  
  
  METHODS
  Cardiac output and plasma sFlt-1 were measured <or=24 weeks' gestation and every 6 to 8 weeks in a longitudinal pilot study of: 1) women with risk factors for preeclampsia (high-risk group; n=46) who were treated with atenolol, and 2) low-risk group (control, n=25) who were not treated.
  
  
  RESULTS
  The groups were similar in maternal age (mean+/-SD: high-risk 28.3+/-5.4 versus control 30.3+/-5.5 years) and enrollment gestational age (17.3+/-4.3 versus 16.1+/-4.2 weeks). The high-risk group had higher cardiac output (9.7+/-1.7 versus 7.3+/-1.7 L/min; p<0.001) and mean arterial pressure (91.8+/-10.6 versus 79.6+/-7.3 mm Hg; p<0.001). Cardiac output and mean arterial pressure decreased while sFlt-1 levels rose less in the high-risk group compared with controls (p=0.001 for all using GEE) even after adjusting for preeclampsia risk factors (age, weight, and primigravida status).
  
  
  CONCLUSIONS
  Atenolol in high-risk women was associated with a lower rise in sFlt-1, suggesting an effect of hemodynamically directed treatment on the anti-angiogenic state.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington 98195-6460, USA. darcarr@u.washington.edu
authors.forename: Darcy B
authors.initials: DB
authors.lastname: Carr
authors.forename: Lan T
authors.initials: LT
authors.lastname: Tran
authors.forename: Debra A
authors.initials: DA
authors.lastname: Brateng
authors.forename: Cydney
authors.initials: C
authors.lastname: Kawamura
authors.forename: Jane B
authors.initials: JB
authors.lastname: Shofer
authors.forename: S Ananth
authors.initials: SA
authors.lastname: Karumanchi
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Easterling
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001262:Atenolol / Q000494:pharmacology / Q000627:therapeutic use*; D016534:Cardiac Output, High / Q000188:drug therapy; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008137:Longitudinal Studies; D010865:Pilot Projects; D011225:Pre-Eclampsia / Q000517:prevention & control*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood*; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D001262:Atenolol; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1