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Abstract-Aim of our study was to ascertain, prospectively, whether serum uric acid is a suitable predictor of preeclampsia and/or the delivery of small-for-gestational-age infants in women with gestational hypertension. We screened 206 primiparas, with a singleton pregnancy, referred for recent onset of hypertension. At presentation, we measured serum uric acid, creatinine, blood glucose, hemoglobin and platelet level, and 24-hour proteinuria, as well as office and 24-hour blood pressures. We followed the women until 1 month after delivery and recorded pregnancy outcome. After logistic regression analysis, uric acid resulted a significant predictor of preeclampsia, with an unadjusted odds ratio of 9.1 (95% CI: 4.8 to 17.4; PϽ0.001); after adjustment for age, gestation week, hemoglobin and platelet levels, serum creatinine, office and 24-hour average systolic and diastolic blood pressures, it was 7.1 (95% CI: 3.2 to 15.7; PϽ0.001). Regarding the association between maternal serum uric acid and the chance of giving birth to a small-for-gestational-age infant, the unadjusted odds ratio was 1.7 (95% CI: 1.4 to 2.2; PϽ0.001), and it was 1.6 (95% CI: 1.1 to 2.4; Pϭ0.02) after adjustment. Receiver operating characteristic analysis showed that serum uric acid, at a 309-mol/L cutoff, predicted the development of preeclampsia (area under the curve: 0.955), with 87.7% sensitivity and 93.3% specificity, and the delivery of small-for-gestational-age infants (area under the curve: 0.784) with 83.7% sensitivity and 71.7% specificity.In conclusion, the results of our study show that serum uric acid is a reliable predictor of preeclampsia in women referred for gestational hypertension. (Hypertension. 2011;58:704-708.)Key Words: uric acid Ⅲ preeclampsia Ⅲ gestational hypertension Ⅲ blood pressure Ⅲ small for gestation age H ypertensive disorders complicate Ϸ2% to 10% of all pregnancies. 1,2 Among these, preeclampsia remains one of the largest single causes of maternal and fetal mortality and morbidity, whereas uncomplicated gestational hypertension carries a far better prognosis. Clinical prediction of preeclampsia may facilitate initiation of timely management to avert mortality and morbidity in the mother and infant. Raised serum uric acid (UA) is one of the characteristic findings in preeclampsia. In clinical practice, serum UA determination is considered to be a part of the workup in women with preeclampsia to monitor disease severity and aid management of these women. The association between raised serum UA and preeclamptic pregnancies was first reported almost a century ago. 3 Reduced UA clearance secondary to reduced glomerular filtration rate, increased reabsorption, and decreased secretion may be at the origin of elevated serum levels in women with preeclampsia. 4,5 Several studies have reported a positive correlation between elevated maternal serum UA and adverse maternal and fetal outcomes. 6 -10 A number of studies 11-15 have evaluated several tests and parameters, including UA, during the first or second trimester of...

In a prospective study, 144 white nuns belonging to a secluded monastic order and 138 white control laywomen were followed for 20 years to investigate whether living for a long time in a stress-free environment influences the effect of aging on blood pressure. Silence, meditation, and isolation from society are the distinctive features of the life-style examined. At study entry, blood pressure was not dissimilar in the nuns and the control group, but it increased over time only in the controls, with a mean slope of the regression line (beta coefficient) of 0.089 in the nuns (NS) and 2.171 in the controls (p less than 0.0001) for systolic blood pressure and of 0.054 in the nuns (NS) and 0.742 in the controls (p less than 0.0001) for diastolic blood pressure. Weight and body mass index increased similarly over time in the two groups. Family history of hypertension was not dissimilar between the groups. Serum cholesterol and triglycerides, higher at study entry in the nuns, increased similarly over time in the two groups. Twenty-four-hour urinary sodium excretion, collected randomly in both groups, did not differ over time between nuns and controls. None of the women smoked or used oral contraceptives. Educational level was higher in the control group, but subgroups of 48 nuns and 52 laywomen of comparable educational level maintained the same difference in the blood pressure trend over time as in the main cohort. Parity affected the increase of systolic, but not of diastolic, blood pressure with age among the laywomen, but nuns and no-childbirth controls maintained a significantly different blood pressure trend over time.(ABSTRACT TRUNCATED AT 250 WORDS)

30-year data are presented on blood pressure and cardiovascular morbidity and mortality for 144 nuns living in a secluded order in six nunnerlie in Umbria, central Italy and 138 lay women from the same region. There were no significant differences at baseline regarding age, blood pressure, body mass index, race, ethnic background, menarche, family history of hypertension or 24-hour urinary sodium excretion. None of the women were smokers and none took birth control pills nor did they use estrogen replacement therapy. During the observation period blood pressure remained remarkably stable among the nuns. None showed a rise in diastolic blood pressure to above 90 mm Hg. On the contrary the lay women showed the expected rise in blood pressure with age. This resulted in a gradually greater difference (delta > 30/15 mm Hg) in blood pressure between the two groups, which was statistically significant. There were 31 fatal and 69 non-fatal cardiovascular events during the 30 years of follow-up. These were significantly more common in the lay women, 10 vs. 21 fatal and 21 vs. 48 non-fatal in the nuns and lay women respectively. It appears reasonable to assume that the difference in psychosocial stress is the main underlying factor for the observed findings.

The powerful effect of psychosocial and acculturating influences on population blood pressure trends seems to be confirmed, through longitudinal observations, in the nuns in a secluded order. After initial observations had been made on culture, body form, blood pressure, diet, and other variables in 144 nuns and 138 lay women, included as a control group, a 30-year follow-up study was undertaken. Most striking were opposite trends noted between the two groups in blood pressure trend. During the follow-up period, blood pressure remained remarkably stable among the nuns. None showed an increase in diastolic blood pressure over 90 mm Hg. By contrast, the control women showed the expected increase in blood pressure with age. This resulted in a gradually greater difference (δ>30/15 mm Hg) in systolic and diastolic blood pressure between the two groups, which was statistically significant. In addition, cardiovascular morbidity and mortality, expressed as the outcome of fatal and nonfatal events, were different in the two groups. They were significantly more common in the lay women than in the nuns. Comparisons between survivalcurves were statistically significant (p = 0.0043 for fatal events; p = 0.0056 for nonfatal events) between the two groups. In conclusion, it seems reasonable to attribute much of the difference in blood pressure and cardiovascular events, to the different burden in psychosocial factor and to the preserved peaceful lifestyle of the nuns.