Hypertension in pregnancy as an early sex-specific risk factor for cardiovascular diseases: evidence and awareness.

Despite being a physiological condition, human pregnancy is known to cause numerous complications that can endanger the life of the mother and the fetus alike. While the majority of complications are mostly limited within the peripartum period, more and more information is available about persistently higher short- and long-term cardiovascular risk after a pregnancy complicated by a hypertensive disorder. There is evidence that women after gestational hypertension or preeclampsia are more likely to develop arterial hypertension, coronary atherosclerosis, myocardial infarction, stroke, peripheral artery disease, and even diabetes mellitus and venous thromboembolism years after the target pregnancy. This has urged some authors to view hypertensive disorders of pregnancy as a "stress test" for the maternal organism that unmasks latent endothelial dysfunction. An explanation is sought in the presence of common risk factors and underlying pathological pathways with cardiovascular diseases, although a certain etiological mechanism for the development of hypertensive disorders in pregnancy has not been established yet. More attention is needed towards the follow-up of women after a hypertensive pregnancy as it could be an opportunity for early prevention of cardiovascular diseases.

Interleukin-6 and its correlations with maternal characteristics and echocardiographic parameters in pre-eclampsia, gestational hypertension and normotensive pregnancy.

BACKGROUND: Pre-eclampsia and gestational hypertension are pregnancy-related disorders with major maternal cardiovascular implications later in life. OBJECTIVES: The aim of this study was to determine interleukin-6 levels in women with pre-eclampsia and gestational hypertension and in healthy pregnant controls, and to examine their correlations with characteristics of the women and echocardiographic findings. METHODS: The ELISA method was used to determine serum interleukin-6 in 36 women with gestational hypertension, 37 women with pre-eclampsia and 50 pregnant controls. The echocardiographic examination was performed according to current recommendations by the European Association of Cardiovascular Imaging and the American Society of Echocardiography. RESULTS: Mean serum interleukin-6 levels were 2.77 pg/ml in the controls, 5.08 pg/ml in the gestational hypertension group and 8.06 pg/ml in the pre-eclampsia group. A significant difference in these levels was present between the controls and both hypertensive groups, but not between the two hypertensive groups. Higher levels correlated with heart chamber enlargement and worse ventricular function. CONCLUSION: Interleukin-6 levels in gestational hypertension and pre-eclampsia were significantly elevated compared to those in healthy pregnancy. Higher levels also corresponded to echocardiographical changes.

High-sensitivity CRP levels in women with gestational hypertension, preeclampsia and in normotensive pregnant women and its correlations.

INTRODUCTION: Gestational hypertension is a less investigated hypertensive disorder of pregnancy than preeclampsia, but evidence exists of an unfavourable cardiovascular profile for women after such a pregnancy. AIM: To determine serum high-sensitivity C-reactive protein (hs-CRP) levels in women with preeclampsia, gestational hypertension, and in normotensive pregnancy in order to assess the cardiovascular implications and to examine its correlations with some characteristics of women. MATERIALS AND METHODS: Thirty-six women with gestational hypertension, thirty-seven with preeclampsia, and fifty maternal and gestational age-matched controls were included in a single-center prospective clinical-epidemiological study. Serum hs-CRP levels were determined using ELISA method. RESULTS: Significantly higher hs-CRP levels were found in the gestational hypertension group than in the controls (p=0.043), but not in the preeclampsia group (p=0.445). The levels between the two pathological groups did not differ significantly (p=0.247). Odds ratio for hs-CRP levels higher than the provided cut-off was 3.31 (95% CI 1.32-8.29) for the presence of gestational hypertension. In the normotensive pregnant women, the hs-CRP levels had a positive correlation with BSA, pre-pregnancy and current BMI, but such correlations were absent in the hypertensive groups. There were no correlations with the maternal or gestational age, current weight gain in any of the groups or with the highest detected blood pressure in the pathological groups. These levels did not differ according to gravidity, smoking status and smoking during pregnancy. CONCLUSIONS: Elevation of hs-CRP was more pronounced in women with gestational hypertension than in women with preeclampsia, which could indicate a different pathophysiological mechanism and a higher cardiovascular risk for those women.

Verification of Bioanalytical Method for Quantification of Exogenous Insulin (Insulin Aspart) by the Analyser Advia Centaur® XP.

BACKGROUND: In a number of cases the monitoring of patients with type I diabetes mellitus requires measurement of the exogenous insulin levels. For the purpose of a clinical investigation of the efficacy of a medical device for application of exogenous insulin aspart, a verification of the method for measurement of this synthetic analogue of the hormone was needed. The information in the available medical literature for the measurement of the different exogenous insulin analogs is insufficient. Thus, verification was required to be in compliance with the active standards in Republic of Bulgaria. A manufactured method developed for ADVIA Centaur XP Immunoassay, Siemens Healthcare, was used which we verified using standard solutions and a patient serum pool by adding the appropriate quantity exogenous insulin aspart. METHODS: The method was verified in accordance with the bioanalytical method verification criteria and regulatory requirements for using a standard method: CLIA chemiluminescence immunoassay ADVIA Centaur® XP. RESULTS: The following parameters are determined and monitored: intra-day precision and accuracy, inter-day precision and accuracy, limit of detection and lower limit of quantification, linearity, analytical recovery. CONCLUSIONS: The routine application of the method for measurement of immunoreactive insulin using the analyzer ADVIA Centaur® XP is directed to the measurement of endogenous insulin. The method is applicable for measuring different types of exogenous insulin, including insulin aspart.

Reference Values of Certain Serum Indicators of Liver Fibrosis.

BACKGROUND: Liver fibrosis shows a continuously increasing trend worldwide, due to alcohol abuse, obesity, and, to a lesser extent, chronic hepatitis B and C. Biopsy is still considered the "gold standard" for diagnosis of liver fibrosis. However, it has a number of limitations, such as invasiveness, high cost, need for specialists to conduct and interpret biopsy results, risk of complications, inability to dynamically monitor the pathological process, low patient compliance, and uneven fibrosis distribution. Therefore, there is an increasing demand for non-invasive serum markers that are characterized by easy implementation, low cost, possible repeatability, and high patient compliance. METHODS: For a period of two years, 82 clinically healthy, middle aged subjects, mean age 40.5 ± 12.37 years, range 21 - 67 years, were studied. The group was tested for platelet count, prothrombin time, and the following biochemical parameters: Cholesterol - total, HDL, LDL; AST; ALT; GGT; total bilirubin, alfa-2-macroglobulin; haptoglobin and ELF (Enhanced Liver Fibrosis). RESULTS: Reference values of a large number of serum indicators of liver fibrosis are disputable and unspecified. A direct proportional and moderate correlation was found between the BMI and AST, ALT, INR, APRI, GPRI, and Forns Index. CONCLUSIONS: We present our original reference values for ELF, AST/ALT, ARPI, GRPI, Fib 4, and Forns Index in 82 clinically healthy subjects.

Albuminuria and Glomerular Filtration in Patients with Essential Hypertension.

BACKGROUND: Essential hypertension (EH) is a widespread disease. One frequent complication of EH is Chronic Kidney Disease (CKD), whose diagnosis is delayed due to its asymptomatic course. The purpose of this study is to determine the involvement of the kidneys in patients with EH by biomarkers for kidney damage (albuminuria) and glomerular filtration rate (GFR) with creatinine and cystatin C. METHODS: We observed a control group of 153 healthy volunteers and a group of 150 patients with EH. The biomarkers we tested were urinary albumin, ACR, total protein, and PCR. The GFR was calculated by the CKD-EPI formula using creatinine simultaneously and by the combined formula CKD-EPI using creatinine and cystatin C. RESULTS: The obtained results for the studied biomarkers in the control group are similar to the ones reported in the literature. In the group of patients with EH (at the time of study none of which had been diagnosed with CKD) we observed albuminuria A2 in 59 of the patients (39.9%) and none with albuminuria A3; increased ACR in 60 patients (40%); PCR above reference range in 42 patients (28%). GFRR was < 60 mL/min/1.73 m2 in 13 patients (8.6%). CONCLUSIONS: These results show that albuminuria A2 and ACR are sensitive, while GFR is a specific biomarker for kidney damage. For patients with EH, a timely follow-up of these biomarkers is necessary in order to decrease the progression of the kidney damage to Chronic Kidney Failure, cardiac complications, and premature mortality.