Pravastatin Treatment for Preeclampsia (p 687)
Preeclampsia is a serious complication affecting 5% to 8% of pregnancies. The preeclamptic placenta releases elevated soluble fms-like tyrosine kinase-1 and soluble endoglin into the maternal circulation, leading to widespread endothelial dysfunction and maternal organ injury. There is no medical treatment and preterm delivery is required to stop the disease from progressing. This can lead to perinatal death and disability arising from prematurity. There is an increasing momentum to consider pravastatin as a treatment for preeclampsia. However, most of the evidence supporting this concept has come from mice models. There has been little evidence generated in human tissues. In this issue of Hypertension, Brownfoot et al report studies showing pravastatin reduces key aspects of preeclampsia in primary human tissues. The group found pravastatin reduced soluble fms-like tyrosine kinase-1 and soluble endoglin secretion from preterm preeclamptic human placenta. This effect was mediated through the 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase cholesterol synthesis pathway. Using multiple endothelial dysfunction assays, Brownfoot et al showed that pravastatin reduced key aspects of vascular dysfunction. Finally, the team administered pravastatin to 4 women with preterm preeclampsia. Excitingly, there was some suggestion that the drug might have stabilized the disease in 3 of the participants (Figure). This work supports the contention that pravastatin may be a promising treatment for preeclampsia, but it should not be used until it has been tested in clinical trials.
N-Terminal Pro-Brain Natriuretic Peptide Predicts Incident Atherosclerotic Cardiovascular Disease Beyond Ambulatory Blood Pressure (p 681)
Improvement of risk prediction for atherosclerotic cardiovascular disease is needed. Both ambulatory blood pressure (ABP) and the biomarkers amino-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein and cystatin C improve risk prediction compared with traditional risk factors, but the additive value of the biomarkers has not been evaluated in relation to ABP. Skoglund et al investigated the predictive value of these biomarkers for incident atherosclerotic cardiovascular disease in a model including traditional risk factors in combination with ABP variables in 907 healthy elderly men from Uppsala, Sweden. The additive value of ABP to a traditional model already including one of these biomarkers was also tested. Results showed that ABP improved discrimination for incident atherosclerotic cardiovascular disease when compared with office BP in a traditional risk factor model and NT-proBNP further improved net reclassification when added to ABP models. ABP improved net reclassification when added to a traditional risk factor model that already included NT-proBNP. NT-proBNP and ABP are widely available and easy to use methods. The results from the study by Skoglund et al indicate that the combination of NT-proBNP and ABP can be used to improve risk prediction for incident atherosclerotic cardiovascular disease in elderly male patients. The application of these methods in tailoring treatment of patients with high blood pressure could be of benefit and may reduce the risk for incident cardiovascular disease.
Blood Pressure Variability and Cerebral Small Vessel Disease (p 634)
Besides blood pressure (BP) levels, BP variability has been independently associated with the risk of cardiovascular events, including stroke. Because hypertension is a major risk factor for cerebral small vessel disease (CSVD), which is a determinant for future stroke and dementia, it might be worthwhile to evaluate whether short-term BP variability relates to the presence of CSVD (Figure). In addition, the contribution of short-term BP variability metrics and BP levels to the diagnosis of CSVD in asymptomatic individuals is not known. In this issue of Hypertension, Filomena et al reported the results of a cohort study involving 487 asymptomatic individuals who underwent brain magnetic resonance imaging and 24-hour ambulatory BP monitoring. CSVD was identified in 18.9% of the participants and was based on the presence of lacunar infarcts and white matter hyperintensity grades. Among 20 different metrics of short-term BP variability, only 24-hour and nocturnal average real variability of systolic BP were independently associated with the presence of CSVD, together with increasing systolic BP levels at any period. When both systolic BP levels and average real variability were increased over 24 hours, the CSVD prevalence was the highest. Nonetheless, their addition to other clinical parameters related to CSVD, such as age, male sex, diabetes mellitus, or office BP, was associated with a small increase in discrimination of CSVD (5.3%), which was not clinically relevant.
- © 2015 American Heart Association, Inc.