Nocturnal Hypertension Is Associated with an Exacerbation of the Endothelial Damage in Preeclampsia

Abstract

Background: Non-dipping pattern of circadian blood pressure in preeclampsia is associated with an increased risk of cardiovascular disease. The pathogenetic mechanisms of this relationship are still unclear. We investigated whether non-dipping in preeclampsia could relate to endothelial activation or damage. Methods: Participants, 20 women with normal pregnancy (mean age 29.9 ± 5.7 years) and 31 women with preeclampsia (mean age 29.1 ± 5.1 years), un- derwent 24-hour ambulatory blood pressure monitoring. Plasma levels of von Willebrand factor (vWf), marker of endothelial damage and of soluble adhesion molecules (sVCAM-1, sICAM-1), and markers of endothelial activation were determined using commercially available enzyme-linked immunoassays. Results: Based on whether the nocturnal mean arterial pressure (MAP) relative to the daytime MAP declined by less than 10%, 21 women with preeclampsia were categorized as non-dippers. Compared to healthy pregnant women, patients with preeclampsia showed significantly enhanced levels of vWf (206.9 ± 40.6 vs. 123 ± 24 IU/dl;p<0.01) and sVCAM-1 (2,269 ± 426 vs.1,159.8 ± 340 ng/ml; p < 0.01). In addition, significantly higher levels of vWf (224.5 ± 34.9 vs. 170 ± 23 IU/dl; p < 0.01) and sVCAM-1 (2,405 ± 421.4 vs. 1,983 ± 276.7 ng/ml; p = 0.007) were determined, when women with preeclampsia and nocturnal hypertension (non-dippers) were compared to dippers. The results were similar even after adjustment for severity of preeclampsia. In contrast, neither preeclampsia nor dipping status had an effect on sICAM-1 levels. Conclusion: Nocturnal hypertension in preeclampsia is associated with elevated levels of molecules related to endothelial damage. Endothelial damage is a recognized pathogenetic factor for atherosclerosis and history of preeclampsia is a risk factor for cardiovascular disease. In this context, possible clinical im-plications of our findings deserve further investigation.

Ambulatory monitoring demonstrates an acute association between cookstove-related carbon monoxide and blood pressure in a Ghanaian cohort

“…The prevalence of non-dipping observed in this cohort is greater than has been reported in several prominent observational studies of ABPM parameters, including 27.8% non-dipping rate reported in the PIUMA study among 959 individuals with ambulatory hypertension in Italy [47], and the 29.4% non-dipping rate reported within the IDACO cohort of 7458 individuals [48]. Non-dipping has been associated with adverse cardiovascular outcomes in a variety of European, American, and Asian cohorts [46, 49], including associations among pregnant women with pregnancy-induced hypertension [50] and increased risk of endothelial damage in preeclampsia [51]. Studies in the United States point to a potential racial and ethnic component of non-dipping patterns, with a larger prevalence of non-dipping SBP observed among African-Americans as compared to other racial groups [52, 53].…”

Melatonin secretion is impaired in women with preeclampsia and an abnormal circadian blood pressure rhythm

“…Moreover, endothelial dysfunction is a key component in preeclampsia 15 and its adverse fetal and maternal outcomes. It has been suggested that administration of melatonin may lead to prevention of endothelial structural alterations.…”

Immunohistochemical expression of von Willebrand factor in the preeclamptic placenta

“…Moreover, vWf has attracted considerable attention in recent years as a marker of endothelial cell activation (Bergmann et al 1991) or injury (Brenner et al 1989). Significantly increased maternal plasma vWf levels have been reported in preeclampsia (Bouchlariotou et al 2008;Hulstein et al 2006;Nadar et al 2004;Peng et al 2010). Additionally, it has been reported that exposing the human umbilical vein to a hypoxic environment stimulates the release of vWf (Pinsky et al 1996;Trampont et al 2004).…”