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Shi L, Yuan F, Wang X, Wang R, Liu K, Tian Y, Guo Z, Zhang X, Wang S. Mineralocorticoid Receptor-Dependent Impairment of Baroreflex Contributes to Hypertension in a Mouse Model of Primary Aldosteronism. Front Physiol 2019; 10:1434. [PMID: 31824340 PMCID: PMC6883352 DOI: 10.3389/fphys.2019.01434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/06/2019] [Indexed: 12/19/2022] Open
Abstract
Primary aldosteronism (PA) is the most common cause of secondary hypertension. The paucity of good animal models hinders our understanding of the pathophysiology of PA and the hypertensive mechanism of PA remains incompletely known. It was recently reported that genetic deletion of TWIK-related acid-sensitive potassium-1 and potassium-3 channels from mice (TASK−/−) generates aldosterone excess and mild hypertension. We addressed the hypertensive mechanism by assessing autonomic regulation of cardiovascular activity in this TASK−/− mouse line that exhibits the hallmarks of PA. Here, we demonstrate that TASK−/− mice were hypertensive with 24-h ambulatory arterial pressure. Either systemic or central blockade of the mineralocorticoid receptor (MR) markedly reduced elevated arterial pressure to normal level in TASK−/− mice. The response of heart rate to the muscarinic cholinergic receptor blocker atropine was similar between TASK−/− and wild-type mice. However, the responses of heart rate to the β-adrenergic receptor blocker propranolol and of arterial pressure to the ganglion blocker hexamethonium were enhanced in TASK−/− mice relative to the counterparts. Moreover, the bradycardiac rather than tachycardiac gain of the arterial baroreflex was significantly attenuated and blockade of MRs to a large degree rescued the dysautonomia and baroreflex gain in TASK−/− mice. Overall, the present study suggests that the MR-dependent dysautonomia and reduced baroreflex gain contribute to the development of hyperaldosteronism-related hypertension.
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Affiliation(s)
- Luo Shi
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
| | - Fang Yuan
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
| | - Xuefang Wang
- Department of Physiology, Hebei North University, Zhangjiakou, China
| | - Ri Wang
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
| | - Kun Liu
- Department of Laboratory Medicine, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Yanming Tian
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
| | - Zan Guo
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
| | - Xiangjian Zhang
- Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio-Cerebrovascular Disease, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Sheng Wang
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
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Kusunoki H, Iwashima Y, Kawano Y, Hayashi SI, Kishida M, Horio T, Shinmura K, Yoshihara F. Circadian hemodynamic characteristics in hypertensive patients with primary aldosteronism. J Hypertens 2019; 36:2260-2268. [PMID: 29846324 DOI: 10.1097/hjh.0000000000001800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The present study aimed to compare circadian hemodynamic characteristics in hypertensive patients with and without primary aldosteronism. METHODS Circadian hemodynamics, including 24-h brachial and central blood pressure (BP), SBP variability indices, central pulse wave velocity (PWV), augmentation index (AIx@75), cardiac index, and total vascular resistance (TVR), were evaluated using an oscillometric device, Mobil-O-Graph, in 60 patients with primary aldosteronism (63.4±13.3 years, 47% women) and 120 age-matched and sex-matched patients with essential hypertension. RESULTS Office SBP, PWV, AIx@75, and BP variability indices were similar between groups; however, 24-h brachial (124 ± 14 vs 130 ± 11 mmHg) as well as central (112 ± 12 vs 120 ± 10 mmHg) SBP was higher (both P < 0.01), and the difference between 24-h brachial and central SBP (11 ± 5 vs 9 ± 3 mmHg, P < 0.05), an index of pressure amplification, was smaller in primary aldosteronism than in essential hypertension. In both groups, cardiac index decreased from daytime to night-time (both P < 0.01), but this decrease was smaller in primary aldosteronism (P < 0.05). During daytime, TVR in primary aldosteronism was higher than that in essential hypertension (P < 0.05), and the significant increase of TVR from daytime to night-time was lost in primary aldosteronism. In a multivariate stepwise regression model, primary aldosteronism emerged as an independent predictor of 24-h central SBP as well as the difference between 24-h brachial and central SBP. CONCLUSION Our results demonstrated that circadian hemodynamics in primary aldosteronism patients are characterized by increased central SBP, smaller disparity between brachial and central SBP, and disturbed circadian hemodynamic variation.
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Affiliation(s)
- Hiroshi Kusunoki
- Division of Hypertension and Nephrology, Department of Medicine, National Cerebral and Cardiovascular Center, Osaka.,Department of General Medicine, Hyogo College of Medicine, Hyogo
| | - Yoshio Iwashima
- Division of Hypertension and Nephrology, Department of Medicine, National Cerebral and Cardiovascular Center, Osaka
| | - Yuhei Kawano
- Division of Hypertension and Nephrology, Department of Medicine, National Cerebral and Cardiovascular Center, Osaka.,Department of Medical Technology, Teikyo University, Fukuoka
| | - Shin-Ichiro Hayashi
- Division of Hypertension and Nephrology, Department of Medicine, National Cerebral and Cardiovascular Center, Osaka
| | - Masatsugu Kishida
- Division of Hypertension and Nephrology, Department of Medicine, National Cerebral and Cardiovascular Center, Osaka
| | - Takeshi Horio
- Department of Internal Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Ken Shinmura
- Department of General Medicine, Hyogo College of Medicine, Hyogo
| | - Fumiki Yoshihara
- Division of Hypertension and Nephrology, Department of Medicine, National Cerebral and Cardiovascular Center, Osaka
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Eguchi K, Hoshide S, Nagashima S, Maekawa T, Sasano H, Kario K. An adverse pregnancy-associated outcome due to overlooked primary aldosteronism. Intern Med 2014; 53:2499-504. [PMID: 25366010 DOI: 10.2169/internalmedicine.53.2762] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 31-year-old woman with treatment-resistant pregnancy-induced hypertension during her first pregnancy delivered a small-for-gestational-age infant (weight: 1,070 g). After delivery, she was diagnosed with primary aldosteronism (PA) associated with a left adrenal adenoma. Following a thorough examination, she underwent laparoscopic left adrenalectomy, and the diagnosis of an aldosterone-producing adenoma was confirmed based on a pathological examination. Thereafter, the patient's hypertension and hypokalemia completely disappeared. She became pregnant again and successfully delivered her second infant at the 37th week of gestation (weight: 2,720 g) without developing treatment-resistant hypertension. Secondary causes of hypertension should not be overlooked, even in young pregnant women.
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Affiliation(s)
- Kazuo Eguchi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Japan
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Matsui Y, Eguchi K, O’Rourke MF, Ishikawa J, Shimada K, Kario K. Association between aldosterone induced by antihypertensive medication and arterial stiffness reduction: The J-CORE study. Atherosclerosis 2011; 215:184-8. [DOI: 10.1016/j.atherosclerosis.2010.12.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 12/03/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
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Epstein M, Calhoun DA. The role of aldosterone in resistant hypertension: Implications for pathogenesis and therapy. Curr Hypertens Rep 2007; 9:98-105. [PMID: 17442219 DOI: 10.1007/s11906-007-0018-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Resistant hypertension constitutes an increasingly common medical disorder. Although the exact incidence is not precisely known, estimates derived from recent outcome studies emphasize that resistant hypertension is much more common than previously thought. A major advance in our understanding of its pathogenesis and management is the recent recognition of the importance of aldosterone excess or autonomy as an important mechanism for drug resistance in hypertension. Recent studies of the effects of aldosterone on vascular smooth muscle have delineated several extra-renal mechanisms whereby aldosterone produces hypertension primarily by its direct vasoconstrictor effects and by altering vascular compliance. Consequently, aldosterone blockade constitutes an effective intervention for treating resistant hypertension.
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Affiliation(s)
- Murray Epstein
- Professor of Medicine, Nephrology Section, VA Medical Center, Miami, FL 33125, USA.
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Abstract
Resistant hypertension is a common medical disorder. Although the exact incidence of resistant hypertension is not established, estimates derived from recent outcome studies including the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), Valsartan Antihypertensive Long-term Use Evaluation (VALUE), and Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) emphasize that this condition may be more common than previously thought. A major advance in our understanding of the pathogenesis and management of resistant hypertension is the recognition of the importance of aldosterone. Several investigators have postulated a direct role of aldosterone excess as an important mechanism for drug resistance in hypertension. The mechanisms whereby aldosterone elevates BP are complex. It was previously thought that aldosterone produced hypertension primarily by promoting sodium retention with consequent hypervolemia. Recent studies of the effects of aldosterone on vascular smooth muscle have, however, delineated several extrarenal mechanisms whereby aldosterone produces hypertension-primarily by its direct vasoconstrictor effects and by altering vascular compliance. Consequently, aldosterone blockade constitutes an effective intervention for treating resistant hypertension.
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Affiliation(s)
- Murray Epstein
- Department of Medicine, University of Miami School of Medicine, Miami, FL, USA.
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Abstract
Animal studies suggest that acute and chronic aldosterone administration impairs baroreceptor/baroreflex responses. We tested the hypothesis that aldosterone impairs baroreflex control of cardiac period [cardiovagal baroreflex sensitivity (BRS)] and muscle sympathetic nerve activity (MSNA, sympathetic BRS) in humans. Twenty-six young (25 +/- 1 yr old, mean +/- SE) adults were examined in this study. BRS was determined by using the modified Oxford technique (bolus infusion of nitroprusside, followed 60 s later by bolus infusion of phenylephrine) in triplicate before (Pre) and 30-min after (Post) beginning aldosterone (experimental, 12 pmol.kg(-1).min(-1); n = 10 subjects) or saline infusion (control; n = 10). BRS was quantified from the R-R interval-systolic blood pressure (BP) (cardiovagal BRS) and MSNA-diastolic BP (sympathetic BRS) relations. Aldosterone infusion increased serum aldosterone levels approximately fourfold (P < 0.05) and decreased (P < 0.05) cardiovagal (19.0 +/- 2.3 vs. 15.6 +/- 1.7 ms/mmHg Pre and Post, respectively) and sympathetic BRS [-4.4 +/- 0.4 vs. -3.0 +/- 0.4 arbitrary units (AU).beat(-1).mmHg(-1)]. In contrast, neither cardiovagal (19.3 +/- 3.3 vs. 20.2 +/- 3.3 ms/mmHg) nor sympathetic BRS (-3.8 +/- 0.5 vs. -3.6 +/- 0.5 AU.beat(-1).mmHg(-1)) were altered (Pre vs. Post) in the control group. BP, heart rate, and MSNA at rest were similar in experimental and control subjects before and after the intervention. Additionally, neural and cardiovascular responses to a cold pressor test and isometric handgrip to fatigue were unaffected by aldosterone infusion (n = 6 subjects). These data provide direct experimental support for the concept that aldosterone impairs baroreflex function (cardiovagal and sympathetic BRS) in humans. Therefore, aldosterone may be an important determinant/modulator of baroreflex function in humans.
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Affiliation(s)
- Kevin D Monahan
- Penn State Heart and Vascular Institute, The Milton S. Hershey Medical Center, Campus Box H047, 500 University Dr., Hershey, PA 17033-2390, USA.
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Abstract
High salt intake contributes to the risk of hypertension, and this effect is in part mediated by the physiologic action of aldosterone on renal mineralocorticoid receptors. However, the actions of aldosterone are not restricted to the kidneys, because aldosterone can bind to mineralocorticoid receptors in the heart, vasculature, and brain to produce structural and functional changes that lead to target organ damage. Experimental and clinical studies show that, in the setting of high salt intake, blocking aldosterone at the mineralocorticoid receptor reduces progression to target organ damage and preserves vascular function. In many cases, these benefits are independent of changes in blood pressure. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have short-term effects on reducing aldosterone levels, but frequently aldosterone levels return to pretreatment levels during long-term therapy. Aldosterone blockade may be more completely achieved with mineralocorticoid receptor antagonists. Spironolactone has been shown to have substantial and significant benefits in experimental and clinical studies of cardiac dysfunction. Eplerenone is a selective aldosterone blocker with a greater binding affinity for mineralocorticoid receptors than for androgen and progesterone receptors. Eplerenone has similarly demonstrated significant benefits in experimental animals and in patients with left ventricular dysfunction after myocardial infarction. Thus, aldosterone blockade with mineralocorticoid receptor antagonists offers target organ protection and may blunt some of the adverse effects of chronic high salt intake.
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Affiliation(s)
- Paul R Conlin
- Division of Endocrinology, Diabetes and Hypertension Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
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Mahmud A, Feely J. Arterial stiffness and the renin-angiotensin-aldosterone system. J Renin Angiotensin Aldosterone Syst 2005; 5:102-8. [PMID: 15526244 DOI: 10.3317/jraas.2004.025] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Arterial stiffness has recently been recognised as an independent risk factor for cardiovascular morbidity and mortality in hypertension. Many of the complications seen with angiotensin II (Ang II) excess or hyperaldosteronism--an increased event rate, left ventricular hypertrophy, endothelial dysfunction and target organ damage--are also associated with arterial stiffness. It is possible that reduced arterial compliance may be one mechanism whereby increased activity of the renin-angiotensin-aldosterone system (RAAS) produces adverse vascular effects. Common pathophysiological processes, altered collagen turnover and increased fibrosis may underlie both arterial stiffness and RAAS-associated vascular damage. While it is recognised that patients with hyperaldosteronism have increased arterial stiffness, the role of the RAAS in modulating arterial compliance in essential hypertension and in normotensive subjects is less clear cut. There is, however, more consistent data which show that drugs that interfere with Ang II or aldosterone, namely angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and aldosterone antagonists, all reduce arterial stiffness. In many cases, this is to a greater extent than predicted from the extent of reduction in blood pressure (BP), suggesting a role for RAAS in vascular stiffness in hypertensive subjects. There is also evidence that combined ACE inhibitors (ACE-Is) and ARBs may have an additive effect in reducing stiffness. The reduction in cardiovascular mortality in end-stage renal disease patients treated with ACE-Is was preferentially seen in those who had reduced arterial stiffness. These data suggest that, in addition to regulation of vascular biology and BP, the RAAS is an important determinant of arterial stiffness in health and, more particularly, in disease.
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Abstract
Blockade of the renin-angiotensin-aldosterone system with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor antagonists has resulted in beneficial effects in essential hypertensive patients. However, occurrence of cardiovascular events has not been appropriately controlled beyond a certain percentage. One reason could be the effects of aldosterone, the final component of the system. The aldosterone escape phenomenon could explain undesirable outcomes observed in hypertensive patients even under treatment with ACE inhibitors or angiotensin antagonists. Aldosterone has direct effects on the vasculature and has been associated with vascular smooth muscle cell hypertrophy, endothelial dysfunction, cardiac fibrosis, proteinuria, and renal vascular injury. Animal models and clinical trials have proven the benefit of aldosterone receptor antagonism. With increased recognition of the prevalence of hyperaldosteronism in patients thought to have "essential" hypertension, the use of drugs that block aldosterone action may become more widespread and protect the vasculature from the deleterious effects of aldosterone.
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Affiliation(s)
- Mario Fritsch Neves
- Clinical Research Institute of Montreal, 110 Pine Avenue West, Montreal, Quebec, Canada H2W 1R7.
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Gomez-Sanchez CE, Gomez-Sanchez EP. Role of central mineralocorticoid receptors in cardiovascular disease. Curr Hypertens Rep 2001; 3:263-9. [PMID: 11353578 DOI: 10.1007/s11906-001-0049-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Mineralocorticoids act directly through their receptors in specific centers in the central nervous system, kidneys, heart, and vascular smooth muscle to mediate hemodynamic homeostasis. These steroids also modulate renal and cardiovascular function indirectly through the autonomic nervous system. Complex homeostatic mechanisms under normal hormonal control become pathogenic when there is an excess of regulatory hormone. Experiments in which mineralocorticoid receptor antagonists or antisense oligodeoxynucleotides were administered centrally have clearly shown that centrally mediated effects on salt appetite, baroreceptor function, and autonomic drive to the renal and cardiovascular systems are crucial to the pathogenesis of hypertension and cardiovascular disease of hyperaldosteronism, and certain forms of genetic hypertension.
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Affiliation(s)
- C E Gomez-Sanchez
- Division of Endocrinology, The University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
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Cat Genova G, Veglio F, Rabbia F, Milan A, Grosso T, Chiandussi L. Baroreflex sensitivity in secondary hypertension. Clin Exp Hypertens 2001; 23:89-99. [PMID: 11270592 DOI: 10.1081/ceh-100001200] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A deranged baroreceptor control of the cardiovascular functions has been reported in essential hypertension. Studies performed in experimental animals and in humans using different approaches have documented an impairment of both baroreflex heart rate modulation (resetting and loss of sensitivity) and baroreceptor control of peripheral vasomotor tone (only resetting). Baroreflex alterations have been reported also in secondary forms of hypertension, but data are controversial. This paper reviews recent works concerning baroreflex function in secondary hypertension. Either structural changes of arterial wall (decrease of vascular distensibility) or functional processes (involving angiotensin II, aldosterone, catecholamines, nitric oxide) have been proposed as potential mechanisms responsible for baroreflex readjustments in secondary hypertension. It remains unclear, and it is difficult to define exactly, if baroreflex changes associated with secondary form of hypertension are primarily due to factors specific for different hypertensive conditions, or merely follow blood pressure elevation.
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Affiliation(s)
- G Cat Genova
- Department of Medicine and Experimental Oncology, University of Turin, Torino, Italy
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Abstract
Although the aldosterone escape mechanism is well known, aldosterone has often been neglected in the pathophysiologic consequences of the activated renin-angiotensin-aldosterone system in arterial hypertension and chronic heart failure. There is now evidence for vascular synthesis of aldosterone aside from its secretion by the adrenal cortex. Moreover, aldosterone is involved in vascular smooth muscle cell hypertrophy and hyperplasia, as well as in vascular matrix impairment and endothelial dysfunction. The mechanisms of action of aldosterone may be either delayed (genomic) or rapid (nongenomic). Deleterious effects of aldosterone leading to vascular target-organ damage include (besides salt and water retention) decreased arterial and venous compliance, increased peripheral vascular resistance, and impaired autonomic vascular control due to baroreflex dysfunction.
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Affiliation(s)
- D Duprez
- Department of Cardiology and Angiology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
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Woisetschläger C, Waldenhofer U, Bur A, Herkner H, Kiss H, Binder M, Laggner AN, Hirschl MM. Increased blood pressure response to the cold pressor test in pregnant women developing pre-eclampsia. J Hypertens 2000; 18:399-403. [PMID: 10779089 DOI: 10.1097/00004872-200018040-00007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Recent data indicate an increased vascular reactivity due to an overactivity of the sympathetic nervous system in women with pre-eclampsia. We therefore evaluated whether this increased vascular reactivity can be detected prior to the clinical manifestation of preeclampsia by the use of a physiological stimulus. DESIGN Prospective data collection. SETTING Clinic of Obstetrics and Gynecology in a 2000 bed tertiary care hospital. PARTICIPANTS One hundred and twenty-three pregnant women between the 16th to 20th week of gestation. INTERVENTIONS A cold pressor test was performed by positioning an ice-bag on the forehead of the woman for 3 min. Blood pressure and heart rate were monitored by a continuous, noninvasive blood pressure measurement device during the stimulus and after removal of the icebag. A clinical follow-up was carried out by review of the charts after delivery to identify those women who have developed pre-eclampsia. RESULTS Ten (8%) out of 123 pregnant women developed pre-eclampsia. During the cold pressor test systolic as well as diastolic blood pressure increased significantly and was more pronounced in women developing pre-eclampsia compared with healthy pregnant women (systolic blood pressure: 14.2 +/- 5.5 versus 8.5 +/- 7.2 mmHg, P= 0.02; diastolic blood pressure: 7.3 +/- 4.9 versus 3.9 +/- 4.7 mmHg, P=0.03). The change in heart rate was similar between both groups (8 +/- 2.6 versus 10.4 +/- 6.4 beats/min, not significant). CONCLUSIONS An increased vasoconstrictive response to a physiological stimulus is present in women with pre-eclampsia as a sign of an increased vascular reactivity prior to clinical manifestation of the disease. The cold pressor test may be a suitable diagnostic tool to identify women, who will develop pre-eclampsia. However, future studies in larger cohorts are required to establish the final value of this test.
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