THE ANGIOTENSIN SENSITIVITY TEST AND LOW-DOSE ASPIRIN ARE INEFFECTIVEMETHODS TO PREDICT AND PREVENT HYPERTENSIVE DISORDERS IN NULLIPAROUS PREGNANCY

OBJECTIVE: Our purpose was to assess the efficiency of the angiotensin sensitivity test as a predictive test for preeclampsia and the effect iveness of low-dose aspirin to prevent preeclampsia when commenced at 28 weeks' gestation in angiotensin II-sensitive women. STUDY DESIGN: A total of 495 healthy nulliparous women underwent the angiotensin sens itivity test at 28 weeks' gestation. The angiotensin II-sensitive wome n were randomized to 60 mg of aspirin or placebo as a subset of a larg e multicenter, randomized, controlled trial of low-dose aspirin therap y in pregnancy. Assessment of the efficiency of the angiotensin sensit ivity test and low-dose aspirin in pregnancy was performed after detai led review of case notes after delivery. The Oxford definition of pree clampsia was used. This includes women without proteinuria but require s blood pressure increments that have been validated to bias the selec tion to primigravid women. RESULTS: Five women had proteinuric preecla mpsia in the angiogensin II-sensitive group randomized to aspirin comp ared with none in the group randomized to placebo. Overall, 11 (25%) o f the women randomized to aspirin had preeclampsia compared with four (11%) randomized to placebo (p > 0.05, not significant). The positive and negative predictive values for the angiotensin sensitivity test we re 19% and 87%, respectively. CONCLUSION: The angiotensin sensitivity test is not an effective screening test for preeclampsia, and low-dose aspirin does not prevent preeclampsia when commenced at 28 weeks' ges tation in angiotensin II-sensitive women.