Effects of blood pressure on orbital and middle cerebral artery resistances in healthy pregnant women and women with preeclampsia

OBJECTIVE: The object of the study was to test the hypothesis that preeclam psia leads to an abnormal vascular response to increasing blood pressure in cerebral vessels by analyzing the relationship between mean arterial press ure and resistance index in the central retinal, ophthalmic, and middle cer ebral arteries in women with normal pregnancies and women with preeclampsia . STUDY DESIGN: Transcranial and color flow Doppler ultrasonographic studies were used to determine systolic, diastolic, and mean velocities and the res istance indexes in the central retinal, ophthalmic, and middle cerebral art eries in 24 women with normal pregnancies and 18 women with preeclampsia. I n each group the relationship between the mean arterial pressure and the re sistance index was determined for each artery by means of linear regression analysis. The Pearson correlation coefficients for each mean arterial pres sure versus resistance index relationship were compared between the groups. In a separate analysis middle cerebral artery data obtained from 79 women with preeclampsia (with and without headache) were compared with data from the normal pregnancy group and analyzed in terms of the relationship betwee n mean arterial pressure and resistance index. RESULTS: The resistance index in women with normal pregnancies decreased wi th increasing mean arterial pressure in all 3 Vessels studied (ophthalmic a rtery r= -0.33, central retinal artery r= -0.43, middle cerebral artery r= -0.30). In the women with preeclampsia, however, as mean arterial pressure increased the resistance index increased in the orbital Vessels and decreas ed in the middle cerebral artery (ophthalmic artery r = 0.54, central retin al artery r= 0.65, middle cerebral artery r= -0.25). The correlation coeffi cients in the women with preeclampsia were significantly different from tho se in the women with normal pregnancies for the ophthalmic and central reti nal arteries (P =.001) but not for the middle cerebral artery (P =.8). With in-group analysis in the patients with normal pregnancies showed no differe nces between the correlation coefficients of the studied vessels. In the wo men with preeclampsia the ophthalmic artery (P=.02) and the central retinal artery (P=.005) were significantly different from the middle cerebral arte ry but not from each other. Women with preeclampsia who had headache had a different correlation coefficient for the middle cerebral artery than did t hose without headache (r= -0.34 versus r= 0.23; P <.001). The correlation c oefficient for the middle cerebral artery for women with preeclampsia witho ut headache was not significantly different from the central retinal artery and ophthalmic artery correlation coefficients in the general preeclampsia group. CONCLUSIONS: Women with preeclampsia demonstrate a different relationship b etween blood pressure and resistance index in the ophthalmic and central re tinal arteries than do women with normal pregnancies. In the middle cerebra l artery, however, preeclampsia does not appear to affect the resistance in dex response to increasing mean arterial pressure in women with headache. I n women with preeclampsia without headache the relationship seen in the oph thalmic artery and central retinal artery is preserved in the middle cerebr al artery. This may indicate a failure in the autoregulatory capacity of th e middle cerebral artery in the presence of headache. Alternatively the res istance index response in the ophthalmic artery and central retinal artery may represent small-caliber vessel vasospasm that is not present in the mid dle cerebral artery in women with preeclampsia who have headache.