Hypertension in pregnant women - a novel cardiorenal continuum


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Abstract

Aim. To investigate cardiorenal correlations in pregnant patients with arterial hypertension.
Material and methods. Risk factors (RF), initial stages, progression, and final stage of both cardiovascular disease (CVD) and chronic kidney disease (CKD) were analysed in a cohort of 159 pregnant women with hypertensive disorders versus a cohort of 32 healthy pregnant controls. Cardiorenal continuum factors were investigated in patients with different ways of gestational hypertension (HT) diagnosis: 13 with isolated clinic HT (ICHT), 11 - isolated ambulatory HT (IAHT), and 18 - HT found by all three blood pressure (BP) measurement modalities (clinic, ambulatory, and home BP).
Results. A novel cardiorenal continuum exists in pregnant women with HT where chronic HT (essential HT) on the one hand and pre-eclampsia on the other hand may lead through the common RF and initial stages (subclinical organ damage) to the stage of progression (CVD, CKD) and to the final stage (cardiovascular events and renal failure). The number of RF, signs of subclinical organ damage, and total cardiovascular risk progressively increase from the condition of being normotensive on clinic, home, and 24-hour definitions to the condition of being found hypertensive by one, two and all three BP measurement methods, forming the continuum "healthy pregnant women - ICHT - IAHT - gestational HT" in which each item is almost the same as the ones next to it but the last is very different from the first.
Conclusion. Assessment of the cardiorenal state in all pregnant women allows to compose the cline "healthy pregnants - gestational HT - stage I essential HT - stage II essential HT - pre-eclampsia - essential HT with superimposed pre-eclampsia" with growing risk of CVD and CKD and a potential danger of cardiovascular events (complications) and chronic renal failure.

About the authors

Il'shat Ravilevich Gaysin

Email: ilshat_gaisin@udm.ru

I R Gaisin

Izhevsk State Medical Academy, Izhevsk

Izhevsk State Medical Academy, Izhevsk

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