Increased sensitivity to angiotensin II is present postpartum in women with a history of hypertensive pregnancy - PubMed (original) (raw)

Increased sensitivity to angiotensin II is present postpartum in women with a history of hypertensive pregnancy

Aditi R Saxena et al. Hypertension. 2010 May.

Abstract

Pregnancies complicated by new-onset hypertension are associated with increased sensitivity to angiotensin II, but it is unclear whether this sensitivity persists postpartum. We studied pressor response to infused angiotensin II in 25 normotensive postpartum women in both high- and low-sodium balance. Ten women had a history of hypertensive pregnancy (5 with preeclampsia; 5 with transient hypertension of pregnancy), and 15 women had a history of uncomplicated, normotensive pregnancy. Systolic and diastolic blood pressures, aldosterone, and soluble fms-like tyrosine kinase 1 levels were measured before and after angiotensin II infusion in both dietary phases. In high sodium balance, women with a history of hypertensive pregnancy were normotensive but had significantly higher systolic and diastolic blood pressures than controls (115 versus 104 mm Hg and 73 versus 65 mm Hg, respectively; P<0.05). Women with a history of hypertensive pregnancy had a pressor response to salt loading, demonstrated by an increase in systolic blood pressure on a high-salt diet. They also had greater systolic pressor response (10 versus 2 mm Hg; P=0.03), greater increase in aldosterone (56.8 versus 30.8 ng/dL; P=0.03), and increase in soluble fms-like tyrosine kinase 1 levels (11.0 versus -18.9 pg/mL; P=0.02) after infusion of angiotensin II in low-sodium balance compared with controls. Thus, women with a history of hypertensive pregnancy demonstrated salt sensitivity of blood pressure and had increased pressor, adrenal, and soluble fms-like tyrosine kinase 1 responses to infused angiotensin II in low-sodium balance. Increased sensitivity to angiotensin II observed during pregnancy in women with hypertensive pregnancy is present postpartum; this feature may contribute to future cardiovascular risk in these women.

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Conflict of interest statement

Conflicts of Interest: None

Figures

Figure 1. Pressor Response to Ang II Based on Salt Intake

Women with history of normotensive pregnancy had a smaller systolic pressor response to Ang II in low sodium balance, compared to high sodium balance. In contrast, women with history of new onset hypertension in pregnancy had similar pressor responses regardless of sodium intake. *In low sodium balance, women with history of new onset hypertension in pregnancy had greater pressor response to Ang II compared to women with history of normotensive pregnancy (p=0.03).

Figure 2. sFlt-1 Response to Ang II in Low Sodium Balance

In women with history of normotensive pregnancy, sFlt-1 levels decreased in response to Ang II in low sodium balance. In contrast, women with history of new onset hypertension in pregnancy demonstrated an increase in sFlt-1 with Ang II stimulation. *In low sodium balance, women with history of new onset hypertension in pregnancy had greater sFlt-1 response to Ang II compared to women with history of normotensive pregnancy (p=0.02).

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Increased sensitivity to angiotensin II is present postpartum in women with a history of hypertensive pregnancy - PubMed (original) (raw)