Hypertensive Phenotypes After Preeclampsia (p 103)
Preeclampsia is associated with a greater lifetime risk for cardiovascular and renal complications. International guidelines underline that women with hypertensive disorders of pregnancy should benefit from a postpartum screening and management of cardiovascular risk factors. However, specific recommendations, especially on the timing of the first medical visit and tests that need to be done, are still lacking. In this study, we performed ambulatory blood pressure monitoring 6 to 12 weeks after delivery in women who had preeclampsia and women who had not (controls). We found that preeclampsia was associated with a higher prevalence of diurnal and nocturnal ambulatory hypertension. Among women with preeclampsia, half of them were still hypertensive in the postpartum, with an increased prevalence of white coat and masked hypertension. They also had an abnormal circadian rhythm with a significant proportion of reversed rhythm. The index of salt-sensitivity risk, calculated from ambulatory blood pressure monitoring parameters, was significantly increased after preeclampsia. Individually, and in the general population, these hypertensive phenotypes are associated with a higher risk for cardiovascular disease later in life. Whether they are contributing factors or a consequence of preeclampsia is not known. Ambulatory blood pressure monitoring after preeclampsia is useful and helps to identify high-risk women. Early lifestyle modifications and regular medical follow-up should be offered to these women. The impact of these measures on future cardiovascular events remains of course to be determined in prospective trials.
Myeloid-Derived Suppressor Cells, Cyclo sporine A, and Hypertension (p 199)
Cyclosporine A (CsA) is prescribed to reduce focal segmental glomerulosclerosis, membranous nephropathy, psoriasis, rheumatoid arthritis, and other autoimmune diseases despite the known prohypertensive side effect. Until new immunosuppressive drugs for these disorders are developed and used routinely in patients, strategies to blunt the negative cardiovascular and renal effects of CsA are needed. We demonstrate that augmenting a particular regulatory immune cell subset, myeloid-derived suppressor cells (MDSCs), is able to eradicate the hypertension, endothelial dysfunction, and vascular and glomerular injury caused by CsA in mice. The protective effects of increased MDSC levels caused by both interleukin-33 treatment and adoptive transfer of MDSCs demonstrate that CsA toxicity can be prevented and reversed. Beneficial effects of MDSCs have been reported in other forms of experimental hypertension and in various inflammatory and autoimmune diseases; therefore, autologous cell therapy with MDSCs may be feasible soon. Groups are generating MDSCs from various cells, including mouse embryonic stem cells and hematopoietic stem cells, as well as human peripheral blood mononuclear cells. Given the strong antihypertensive and organ-protective effects, MDSC therapy should be tested in patients being treated with CsA.
Pregnancy History and Cerebrovascular Reactivity (p 110)
Hypertension during pregnancy is associated with an increased risk of developing cardiovascular or cerebrovascular disease later in life. Our group has shown that postmenopausal women who have experienced preeclampsia have lower brain volume and cognitive scores compared with women who had a normotensive pregnancy. The mechanisms underlying the interaction between pregnancy history and brain structure and function have not been elucidated. Because pregnancy-related changes in the circulation may contribute to pathological changes in the brain, we investigated cerebral blood flow reactivity and markers of vascular activation in women with a history of preeclampsia. In this study in Hypertension, women who either had a normotensive or preeclamptic pregnancy between 1976 and 1982 were recruited ≈35 years after the pregnancy. Women with a history of preeclampsia had lower cerebral blood flow velocity and reduced cerebrovascular reactivity, indicating cerebral microvascular dysfunction, compared with women with a history of normotensive pregnancy. Additionally, procoagulant circulating blood elements were associated with cerebral hemodynamic variables only in women with history of preeclampsia. Collectively, these results suggest that differences in circulating vasoactive factors in women with a history of preeclampsia might affect the reactivity of the cerebral circulation years beyond the preeclamptic pregnancy. These differences may contribute to brain atrophy and increased risk of cognitive decline in women with a history of preeclampsia.
- © 2017 American Heart Association, Inc.