Elevated Blood Pressure and Stage 1 Hypertension in Pregnancy: A Review of the Literature.

Importance: Maternal and perinatal morbidity/mortality is significantly increased in pregnancies complicated by hypertension. The definition of hypertension has recently changed with the addition of 2 categories: elevated blood pressure (BP) and stage 1 hypertension. Should these categories be considered during pregnancy? Objective: The aim of this study was to analyze the impact of the new hypertensive categories of elevated BP and stage 1 hypertension on maternal/perinatal outcomes. Methods: Literature search of PubMed, Web of Science, and CINAHL search was undertaken. Citations were limited to the past 20 years. Results: Of the 333 articles identified, 26 articles were the basis of this review. In 2017, new guidelines on the diagnosis and management of hypertension were published. Prepregnancy hypertension was replaced by elevated BP (systolic BP 120-129 mm Hg and diastolic BP <80 mm Hg) and stage 1 hypertension (systolic BP 130-139 mm Hg and diastolic BP 80-89 mm Hg). The risk factors for elevated BP and stage 1 hypertension are similar to chronic hypertension (CHTN) risk factors, diagnosed by BP readings before pregnancy or before 20 weeks' gestation. Patients with elevated BP and stage 1 hypertension are at increased risk for hypertensive disorders of pregnancies compared with normal patients. Treatment strategies for elevated BP and stage 1 hypertension are uncertain. Before 2017, these patients would not have been considered hypertensive and no guidelines existed. Conclusions: Elevated BP and stage 1 hypertension increase the number of women labeled with hypertension in pregnancy. These women are at increased risk for adverse perinatal and maternal outcomes. There are currently no firm guidelines on management during pregnancy.

ZnO Nanoparticles Protect RNA from Degradation Better than DNA.

Gene therapy and RNA delivery require a nanoparticle (NP) to stabilize these nucleic acids when administered in vivo. The presence of degradative hydrolytic enzymes within these environments limits the nucleic acids' pharmacologic activity. This study compared the effects of nanoscale ZnO and MgO in the protection afforded to DNA and RNA from degradation by DNase, serum or tumor homogenate. For double-stranded plasmid DNA degradation by DNase, our results suggest that the presence of MgO NP can protect DNA from DNase digestion at an elevated temperature (65 °C), a biochemical activity not present in ZnO NP-containing samples at any temperature. In this case, intact DNA was remarkably present for MgO NP after ethidium bromide staining and agarose gel electrophoresis where these same stained DNA bands were notably absent for ZnO NP. Anticancer RNA, polyinosinic-polycytidylic acid (poly I:C) is now considered an anti-metastatic RNA targeting agent and as such there is great interest in its delivery by NP. For it to function, the NP must protect it from degradation in serum and the tumor environment. Surprisingly, ZnO NP protected the RNA from degradation in either serum-containing media or melanoma tumor homogenate after gel electrophoretic analysis, whereas the band was much more diminished in the presence of MgO. For both MgO and ZnO NP, buffer-dependent rescue from degradation occurred. These data suggest a fundamental difference in the ability of MgO and ZnO NP to stabilize nucleic acids with implications for DNA and RNA delivery and therapy.