Are gestational and essential hypertension similar? Left ventricular geometry and diastolic function.

OBJECTIVE: To evaluate the differences and similarities in diastolic function and left ventricular geometry in gestational and essential hypertension. METHODS: Thirty-nine consecutive gestational hypertensive pregnant women in the third trimester of gestation (GH), 40 nonpregnant essential hypertensive women (EH), and 38 normotensive nonpregnant women (N) matched for age were enrolled into the study and underwent echocardiographic and Doppler evaluations. The GH and EH patients were evaluated prior to the administration of any drug treatment. RESULTS: Left atrial function was similar in GH and N subjects and lower than that in EH patients. Both GH and EH patients had early left ventricular diastolic filling pattern significantly different as compared to N subjects (longer isovolumetric relaxation time, deceleration time of the E wave, and lower E wave velocity in GH and EH vs. N), whereas the late filling properties were similar in GH and N subjects with a lower A velocity, and velocity-time integral vs. EH (p < 0.05). Systolic fraction of the pulmonary vein flow was similar in GH and EH patients and lower in N subjects. Altered left ventricular geometry was more common in GH than in EH, whereas normotensive subjects did not show any alteration of the geometric pattern. CONCLUSIONS: Gestational and essential hypertension induce similar early altered diastolic filling of the left ventricle. Essential hypertension is characterized by a compensatory late filling mechanism due to an enhancement of left atrial function. Gestational hypertension is characterized by altered left ventricular geometry, which is far less common during essential hypertension.

Nifedipine-induced changes in body composition in hypertensive patients at term.

BACKGROUND: There are few studies on the effect of nifedipine on fluid homeostasis during pregnancy. OBJECTIVE: To assess the variation of body composition at term in patients with normal pregnancy and patients with gestational hypertension (GH) treated with nifedipine. METHODS: Seventeen healthy patients with singleton pregnancies and 12 non-proteinuric patients with gestational hypertension treated with nifedipine were enrolled consecutively from our University Hospital from January 2000 to January 2001. Two evaluations were performed (anthropometric measurements, bioelectric impedance analysis (BIA) at 5, 50 and 100kHz and hematocrit), the first at 36.4+/-3.2 weeks' gestation, the second at 2.1+/-1.6 days of puerperium. The BIA measurements included: fat mass (FM, kg), fat-free mass (FFM, kg), extra-cellular water (ECW, Lt), intra-cellular water (ICW, Lt), total body water (TBW, Lt). Values were analyzed as mean+/-S.D. and statistical analysis was performed by using the Student's t-test for unpaired data. RESULTS: Birthweights were significantly lower in the gestational hypertensive patients (3472.7+/-266.4g versus 2735.8+/-575.9g, P<0.001). At the first study time, systolic and diastolic blood pressure were significantly higher in the hypertensive patients than in control group, notwithstanding the therapy. Interestingly we found pre-delivery and post-delivery TBW higher in gestational hypertensive patients versus the control patients (44.48+/-9.12Lt versus 36.60+/-5.07Lt, P<0.001 and 40.69+/-4.31Lt versus 37.30+/-4.35Lt, P=0.016, respectively). TBW loss after delivery was greater among hypertensive patients (3.79+/-4.81Lt versus -0.70+/-0.72Lt, P<0.001). CONCLUSIONS: Bioelectrical impedance analysis is a practical tool in the follow-up of anti-hypertensive therapy at term gestation. Moreover, nifedipine increases TBW in gestational hypertensive patients, reverting the pathophisiological pattern, yet described elsewhere.

Left ventricular concentric geometry as a risk factor in gestational hypertension.

In the past, an adverse prognostic significance of an altered left ventricular geometry in essential hypertension has been demonstrated. There are no data on the prognostic significance of an altered cardiac structure during pregnancy. The present study was designed to evaluate the prognostic impact on the outcome of pregnancy of an altered geometry of the left ventricle in mild gestational hypertension. One hundred forty-eight consecutive, pregnant, mild gestational hypertensive women (systolic and diastolic blood pressure, 140 to 150 mm Hg and 90 to 99 mm Hg, respectively) were included in the study. Patients were monitored until term to detect subsequent fetal and/or maternal adverse outcomes (preeclampsia, preterm delivery, abruptio placentae, other maternal medical problems, fetal distress, neonatal low birth weight, admittance to neonatal intensive care unit). One hundred one gestational hypertensive patients (68.2%) had an uneventful pregnancy; 47 patients (31.8%) showed a subsequent development of maternal and/or fetal complications. Concentric geometry was prevalent among patients with the subsequent development of complicated gestational hypertension (37 out of 47 patients) compared with the uneventful gestational hypertensive patients (31 out of 101 patients; 78.7% versus 30.1%; P=0.0001). The multivariate analysis showed concentric geometry as an independent predictor of adverse outcomes (odds ratio, 3.65; 95% confidence interval, 1.30 to 10.27; P=0.014). In patients with gestational hypertension, blood pressure values alone appear to be insufficient to identify the effective risk of adverse events. Ventricular geometry gives additional prognostic information, possibly improving our clinical ability to follow and eventually treat these patients.

Total body water estimation and maternal cardiac systolic function assessment in normal and gestational hypertensive pregnant women.

BACKGROUND: The importance of establishing correlations between cardiac function (cardiac output and stroke volume) and total body water (TBW) content in normal and hypertensive pregnancy focuses primarily on their potential relevance in treatment. Total body water content and cardiac function were evaluated in 25 normotensive (N) and 22 gestational hypertensive (GH) pregnant women matched for age, gestational age, and pre-pregnancy body mass index (BMI) during the third trimester of gestation. MATERIAL/METHODS: Patients underwent maternal echocardiography, bioelectrical impedance analysis (BIA), and hematocrit (Hct) evaluation, and the water balance index (WBI), i.e. the ratio of total body water to hematocrit, was computed. Hematocrit showed significantly lower values in normal than in GH women (31.9+/-2.2% vs. 36.2+/-2.5%; p<0.001). RESULTS: There was no difference in TBW between the two groups. The WBI was higher in normal than in GH women (1.35+/-0.20 l.kg-1.m-2 vs. 1.19+/-0.18 l.kg-1.m-2; p<0.001). Normal subjects showed a higher stroke volume than GH patients (78.0+/-9.7 ml vs 67.9+/-10.2 ml; p=0.001). Atrial function was also higher in normal than in GH women (left atrial fractional area change: 57.4+/-5.1% vs. 42.5+/-7.5%; p<0.001). Correlation was found between stroke volume and WBI (r=0.93, p<0.0001). CONCLUSIONS: Maternal cardiac function and the water balance index are strongly related and might help in comprehending the mechanisms of adaptation in physiologic and hypertensive pregnancy.