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(Hypertension. 2005;46:1250.)
© 2005 American Heart Association, Inc.

Editorial Commentaries

Hypertension During Pregnancy

A Disorder Begging for Pathophysiological Support

Ravi I. Thadhani; Richard J. Johnson; S. Ananth Karumanchi

From the Departments of Medicine and Obstetrics and Gynecology (R.T.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Departments of Medicine and Obstetrics and Gynecology (S.A.K.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; and Division of Nephrology (R.J.J.), Hypertension and Transplantation, University of Florida, Gainesville.

Correspondence to Ravi I. Thadhani, MD, MPH, Bullfinch 127, 55 Fruit St, Massachusetts General Hospital, Boston, MA 02114. E-mail thadhani.r@mgh.harvard.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Hypertension during pregnancy remains a common and potentially devastating complication.^1,2 Hypertension can be isolated (gestational hypertension) or associated with proteinuria (preeclampsia) and, rarely, can manifest as a consequence of either preexisting or new onset renal (usually glomerular) disease. Preeclampsia is a particularly worrisome diagnosis, because it carries increased risk for morbidity to the mother and child and may accelerate to the condition of eclampsia in which seizures develop in association with a high risk for fetal and maternal mortality.

Although, ideally, the diagnosis of these conditions should involve the use of biomarkers that reflect the underlying pathophysiology of the disease process, the lack of clinically available assays has forced the clinician to diagnose the condition based solely on the clinical presentation. Unfortunately, although establishing cut points for elevated blood pressure and urine protein excretion appears to be straightforward, these continuous variables lend themselves to arbitrary definitions, and this likely explains why the precise definition of preeclampsia has changed several times and why different organizations continue to classify preeclampsia differently.³ A recent report from the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy³ nicely summarized the current status of diagnosing preeclampsia: "Although our current understanding of this syndrome has increased, the criteria used to identify the disorder remain subject to confusion and controversy. The confusion doubtless reflects the fact that preeclampsia is a syndrome, which means that attempts at definition use arbitrarily selected markers rather than changes of pathophysiologic importance." Adding to this confusion is . . . [Full Text of this Article]

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				J. S. Gilbert, M. J. Ryan, B. B. LaMarca, M. Sedeek, S. R. Murphy, and J. P. Granger Pathophysiology of hypertension during preeclampsia: linking placental ischemia with endothelial dysfunction Am J Physiol Heart Circ Physiol, February 1, 2008; 294(2): H541 - H550. [Abstract] [Full Text] [PDF]