HYPERTENSION IN PREGNANCY

Pregnancy-induced hypertension (PIH) is a frequent cause of maternal a nd neonatal morbidity and mortality. In the present study we focused o n the pathophysiology of PIH, mainly on the role of mineralocorticoids , reversed blood pressure patterns, and the resulting necessity of con tinuous monitoring of the preeclamptic mother. Problems of antihyperte nsive therapy are discussed and the first results of a pilot study wit h Urapidil are presented. To examine the role of mineralocorticoids in the pathophysiology of PIH, we studied plasma aldosterone and 18-hydr oxy-corticosterone (18-OH-B) levels in 25 women with PIH and in 25 hea lthy pregnant women. Furthermore, we evaluated the mineralocorticoid r eceptor (MR) count in mononuclear leukocytes in the 2 groups. The MR-c ount was significantly decreased in the PIH-group. The values of plasm a aldosterone and 18-OH-B were also low. These results cannot be expla ined by receptor down-regulation due to higher level of mineralocortic oids of the zona glomerulosa. Perhaps deoxycorticosterone or a hithert o unknown mineralocorticoid is responsible for the hypertension and al tered MR-status. The first results of continuous blood pressure measur ements with a noninvasive, real-time blood pressure monitor (Finapres) are presented. The comparison of the obtained values with intraarteri al measurements demonstrates a good correlation between the two method s. We also report on the first experiences with Urapidil in the treatm ent of hypertension in severe preeclampsia. The data show that hyperte nsion in preeclamptic women can be treated by Urapidil without side ef fects or reflextachycardia. Further studies will have to prove if Urap idil is suited for prepartal treatment of PIH as well.