Key result
Among women with pregnancy-induced hypertension, the presence of pathological flow velocity waveforms was associated with significantly higher plasma ANP levels (median 23.0 vs 13.8 pmol/l; P=0.03).
Observational (n=110)
Absolute Event Rate: 23% vs 13.8%
p-value: p=0.03
In pregnancy-induced hypertension, elevated plasma ANP is associated with pathological flow velocity waveforms suggesting vasospasm, likely as a compensatory mechanism, whereas peripheral endothelin levels are not significantly increased.
ANP elevation may mark vasospasm in PIH but should not change practice; leaves open its utility pending prospective validation.
OBJECTIVE: To investigate the relation between concentrations of endothelin and atrial natriuretic peptide (ANP) in maternal plasma and vasospasm in the uterine and umbilical arteries as detected by duplex pulsed colour Doppler ultrasonography in hypertensive pregnancies. DESIGN: An observational study. SUBJECTS: 32 women admitted consecutively to hospital with pregnancy induced hypertension (seven without proteinuria and 25 with proteinuria) and 78 healthy pregnant women examined at 28-40 weeks gestation. MAIN OUTCOME MEASURES: Systolic/diastolic (S/D) ratio in flow velocity waveforms (FVWs) and plasma concentrations of endothelin and ANP in the 32 women with pregnancy induced hypertension; plasma concentrations of endothelin and ANP in 78 healthy pregnant women (controls). RESULTS: Pathological FVWs suggesting vasospasm in the uterine or umbilical artery, or both arteries, were found in 12 women with hypertension. Plasma ANP was significantly higher (P = 0.03) in the women with hypertension and pathological FVWs (median 23.0, range 10.1-52.8 pmol/l) than in those with hypertension and normal FVWs, (median 13.8, range 5.3-42.3 pmol/l) but corresponding plasma endothelin levels did not show any significant difference (median 1.63, range 0.51-3.33 pmol/l and median 1.38, range 0.51-3.51 pmol/l, respectively). CONCLUSION: Local release of endothelin from the vascular endothelium is thought to cause vasospasm in pregnancy induced hypertension but this does not seem to increase the concentration of endothelin in the maternal peripheral plasma, probably because of its rapid disappearance from the blood circulation. As ANP dilates the blood vessels, the increase of its release in hypertensive pregnancies may be a compensatory mechanism against vasospasm.
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Lumme et al. (1992) conducted an observational in Pregnancy induced hypertension (n=110). Pathological flow velocity waveforms (vasospasm) vs. Normal flow velocity waveforms was evaluated on Plasma ANP concentration (pmol/l) (p=0.03). Among women with pregnancy-induced hypertension, the presence of pathological flow velocity waveforms was associated with significantly higher plasma ANP levels (median 23.0 vs 13.8 pmol/l; P=0.03).
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