title: Cerebral perfusion pressure in women with preeclampsia is elevated even after treatment of elevated blood pressure.
abstract: Cerebral perfusion pressure (CPP) is elevated in preeclampsia, and may predispose to cerebrovascular complications and progression to eclampsia. We estimated zero flow pressure (ZFP) and CPP using simultaneously obtained arterial blood pressure and middle cerebral artery blood flow velocity in 10 women with preeclampsia, all treated with methyldopa with or without nifedipine, and 18 healthy pregnant controls. Mean ± SD ZFP was lower in women with preeclampsia than in controls (16.8 ± 10.9 vs. 31.7 ± 15.0 mmHg, p = 0.01) whereas CPP was considerably higher (82.3 ± 17.7 vs. 55.0 ± 11.7 mmHg, p < 0.001), as was the cerebral flow index (41.9 ± 18.0 vs. 25.6 ± 11.2, p = 0.02). There was a significant correlation between blood pressure and CPP in women with preeclampsia, but not in controls. Women with preeclampsia may have an increased cerebral perfusion due to a reduced ZFP and increased CPP despite treatment with antihypertensive medication. More rigorous antihypertensive therapy, aimed at reducing CPP, could result in a decrease in cerebral complications in women with preeclampsia.
authors.affiliation: Department of Clinical Neurophysiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Obstetrics and Gynecology, Division of Obstetrics and Perinatal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
authors.forename: Milan J
authors.initials: MJ
authors.lastname: Sonneveld
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Brussé
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Duvekot
authors.forename: Eric A P
authors.initials: EA
authors.lastname: Steegers
authors.forename: Frank
authors.initials: F
authors.lastname: Grune
authors.forename: Gerhard H
authors.initials: GH
authors.lastname: Visser
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D062186:Arterial Pressure; D001783:Blood Flow Velocity; D016022:Case-Control Studies; D002536:Cerebral Arteries / Q000503:physiopathology*; D054022:Cerebrum / Q000098:blood supply*; D005260:Female; D006801:Humans; D008750:Methyldopa / Q000627:therapeutic use; D009543:Nifedipine / Q000627:therapeutic use; D011225:Pre-Eclampsia / Q000188:drug therapy / Q000503:physiopathology*; D011247:Pregnancy; D012039:Regional Blood Flow
chemical_list: D000959:Antihypertensive Agents; D008750:Methyldopa; D009543:Nifedipine
keywords: Preeclampsia; autoregulation; cerebral perfusion; transcranial Doppler; zero flow pressure