Antihypertensive therapy and central hemodynamics in women with hypertensive disorders in pregnancy.
OBJECTIVE
To estimate the changes in central hemodynamics features of pregnant women presenting with hypertensive disorders and to analyze the effects of standard antihypertensive treatment on maternal central hemodynamics.


METHODS
Applanation tonometry was used to record the radial artery pulse waveform in 80 women presenting with preeclampsia or gestational hypertension and 80 normotensive controls matched for gestational age. In each case, an averaged aortic waveform was derived and analyzed to calculate augmentation pressure and augmentation index at heart rate 75 beats per minute (bpm).


RESULTS
In women with preeclampsia and gestational hypertension, both augmentation pressure (P<.001 and P<.05, respectively) and augmentation index at heart rate 75 bpm (P<.001 and P<.001, respectively) were significantly higher than in controls. Augmentation pressure and augmentation index at heart rate 75 bpm were significantly higher in early- compared with late-onset preeclampsia (P<.001) and in severe compared with mild preeclampsia (P<.001). Antihypertensive therapy with alpha methyldopa resulted in a significant fall in both augmentation pressure and augmentation index at heart rate 75 bpm in preeclampsia (P<.001) but not in gestational hypertension.


CONCLUSIONS
Arterial stiffness is increased in women with hypertensive disorders of pregnancy compared with normotensive controls. In preeclampsia, vascular stiffness was significantly improved by antihypertensive treatment with alpha methyldopa, but remained higher than in normotensive controls.
Khalil
Asma
A
From the The Homerton University Hospital NHS Trust, Queen Mary and Westfield College, University of London; and Academic Department of Obstetrics and Gynaecology, UCL Institute for Women's Health, University College London, London, United Kingdom.
Jauniaux
Eric
E
Harrington
Kevin
K
D000316:Adrenergic alpha-Agonists / Q000494:pharmacology / Q000627:therapeutic use; D001158:Arteries; D001794:Blood Pressure / Q000187:drug effects; D001916:Brachial Artery / Q000503:physiopathology*; D004548:Elasticity; D005260:Female; D006339:Heart Rate; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000188:drug therapy* / Q000503:physiopathology*; D008750:Methyldopa / Q000627:therapeutic use; D008875:Middle Aged; D011247:Pregnancy; D017534:Radial Artery / Q000503:physiopathology
D000316:Adrenergic alpha-Agonists; D008750:Methyldopa