Matrix metalloproteinases (MMPs) are a family of endopeptidases that degrade the components of the extracellular matrix (ECM) such as collagen, and thus contribute to the remodelling and the physiological homeostasis of the ECM and its blood supply. The activities of these enzymes are regulated by endogenous tissue inhibitors of metalloproteinases (TIMPs), and it has been suggested that a balance between MMPs and TIMPs plays an important role in vascular remodelling, angiogenesis and vasodilatation in a number of physiological situations. It follows that, regarding a relationship between MMPs and TIMPs, an imbalance between these molecules may lead to pathology in a wide range of conditions, including hypertension, cancer and pulmonary disease, and in the pathophysiology of reproduction. Indeed, regarding the latter, abnormalities in the maternal peripheral vasculature have been proposed as being (partly) responsible for the effects of hypertension on pregnancy and the development of complications including pre-eclampsia and eclampsia. However, the associations between MMPs, TIMPs and disease may be simply of association, not of pathology. This brief review explores current literature on the role of abnormalities of the ECM in general, focusing on the pathogenesis of hypertension and its complications during pregnancy as a model of disordered angiogenesis and remodelling.

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We have not found any convincing excess of congenital anomalies in women taking angiotensin-blocking drugs in early pregnancy. However, this does not exclude the possibility that ACE-I or ARB use in pregnancy might lead to adverse obstetrical outcomes. Until this matter is settled, we support recommendations that these drugs should not be used in pregnancy or in women who are likely to become pregnant.

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Hypertension is the most common medical condition encountered in and complicating pregnancy, with significant implications on maternal and perinatal morbidity and mortality. It is also one of the areas of clinical practice that has been studied extensively, yet less well understood. The hypertensive disorders of pregnancy are a spectrum of conditions that are classified into 4 categories based upon recommendations of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. This article provides an overview of the pathophysiology and current pharmacologic management of hypertension in pregnancy.

Management of heavily calcified lesions during percutaneous coronary intervention (PCI) is often associated with high incidence of complications and long-term adverse outcomes. There is growing evidence of the efficacy of intravascular lithotripsy (IVL) in de novo coronary lesion preparation; however, little experience has been documented within freshly deployed stent underexpansion. We report a 66-year-old male with a marked stent underexpansion despite extensive lesion preparation due to severe underlying calcification. The stent was resistant to balloon postdilatation; therefore, IVL was applied, resulting in excellent stent expansion. IVL could be considered for treating acute stent underexpansion caused by severe underlying calcification.

Introduction. Primary aldosteronism (PA) is caused by autonomous hypersecretion of aldosterone from the adrenal cortex, classically from an adenoma, resulting in sodium and water retention, hypokalaemia and raised blood pressure. The sodium and water retention causes suppression of renin release. The possible cardiac sequelae of aldosterone excess are encountered primarily in patients with secondary hyperaldosteronism due to heart failure, where plasma renin, angiotensin and aldosterone levels are all raised. However, there is also evidence that primary aldosterone excess, in the presence of low renin levels, may also be cardiotoxic. Patients. In this report, we describe five patients with PA, who developed atrial fibrillation (AF) in the absence of structural cardiac lesions and in one case despite good control of blood pressure and electrolytes. Conclusion. In patients with hypertension and AF, who have no evidence of coronary disease or any other underlying cause of AF with preserved systolic function, a diagnosis of PA should be considered.

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