American Society of Hypertension Presents New Position Paper on Hypertension and Pregnancy

Newswise — A position paper on hypertension in pregnancy published in the Journal of the American Society of Hypertension points to potential breakthroughs in predicting and treating preeclampsia and discusses recent evidence about the disease's cause and connection to cardiovascular disease later in life. The paper addresses historic misunderstandings surrounding the classification, diagnosis and management of preeclampsia " a rapidly progressive condition in pregnancy, characterized by high blood pressure, the presence of protein in the urine, as well as life- threatening pathology in other organ systems including the liver and brain. "For decades preeclampsia has been dubbed 'the disease of theories,' remaining among the most understudied areas and lowest recipients of research funds compared to other diseases in terms of disability adjusted life years (DALYs), all despite the fatal consequences of its mismanagement," said lead author Marshall D. Lindheimer, M.D., Professor Emeritus, Medicine and Obstetrics & Gynecology, University of Chicago Pritzker School of Medicine. Once preeclampsia is diagnosed, some experts argue that classification terms such as 'mild' and 'severe' are misleading. Due to its explosive nature, the authors of the position paper recommend hospitalization if preeclampsia is suspected. This minimizes risk if the disorder suddenly progresses to a life-threatening phase or the patient unexpectedly convulses when away from the hospital. Preeclampsia usually develops after the twentieth week of pregnancy and symptoms may include sudden weight gain, swelling, headaches, changes in vision, nausea, vomiting and upper abdominal pain. It is an explosive disease which can progress rapidly from a mild state into a life-threatening one. Approximately three women each week die from the disease in the U.S. alone and those who do not die from it can lose their babies, experience trauma and suffer lifelong disabilities including paralysis, blindness and other permanent neurological impairment. Preeclampsia costs the U.S. alone more than $7 billion annually. Globally, it causes between 50-70,000 maternal and approximately 500,000 infant deaths each year. It is also a major cause of pre-term birth and the significant, immediate and long term health burden associated with prematurity. Currently, delivery is the only cure so experts are calling for more effective management of this devastating disease and the need for research to learn how to prevent or reverse it, the latter prolonging the pregnancy and ensuring a better fetal outcome. Experts also recommend that near term, induction of labor should be the therapy of choice with attempts to postpone labor if pregnancy is at an earlier stage. If physicians opt to postpone labor and blood pressure rises to unacceptable levels, the authors note that several antihypertensive agents could be considered safe in pregnancy. Delivery is recommended at any stage of the pregnancy if severe hypertension remains uncontrolled for 24 to 48 hours or if signs of abnormal clotting and other serious complications emerge. "Researchers are currently addressing key questions that have remained unanswered for years, resulting in bad pregnancy outcomes and even maternal and fetal deaths," said Dr. Lindheimer. "In particular, encouraging early results from several major studies show that excessively high maternal levels of antiangiogenic factors may be circulating eight weeks prior to the disease, making early prediction possible. Also, armed with new laboratory findings on the cause of preeclampsia, some very early human studies have begun, and others will begin shortly, to see if treating with the hormone relaxin could reverse the disease and prolong the pregnancy. These increases in both basic and clinical research are important steps forward and could lead to more lives being saved if coupled with a more effective, interdisciplinary management approach between hypertensive experts and obstetricians," said Dr. Lindheimer. Proteins Hold Promise of PredictionCurrently there is no reliable test to predict preeclampsia, yet early prediction is key to preventing fatalities. New research outlined in this paper suggests that measuring a group of proteins (combinations of sFlt-1, sEng and PIGF) produced by the placenta may have predictive value. Prediction of preeclampsia " based on antiangiogenic proteins that reach abnormally high levels in the mother's bloodstream and subsequently lead to dysfunction of the cells that line the inner surface of blood vessels " may prove useful in the differential diagnosis of the disease and could change the course of future treatment. The authors also note the link between hypertension in pregnancy caused by preeclampsia and the development of cardiovascular disease later in life. They recommend that patients be aware of their risk and point to the role of hypertensive experts in encouraging more frequent physician visits along with diet and lifestyle changes. "We are excited and optimistic about the progress being made to help manage preeclampsia," said Eleni Z. Tsigas, preeclampsia survivor and Immediate Past Chair of the Preeclampsia Foundation Board of Directors. "We hope that all care providers recognize the diligence required to avoid traumatic health outcomes and understand the importance of physician/patient communication to improve diagnosis and overall management of this devastating, greatly misunderstood condition." The President of the American Society of Hypertension, Henry Black, M.D., concluded that "this forward-thinking position paper on hypertension in pregnancy provides invaluable insights for hypertensive experts who are managing patients alongside the obstetrician." Dr. Black noted that the authors of this paper are steering physicians in a much needed new direction and offering important context for them to align in terms of detecting and managing the disease. "We are cautiously optimistic that should the approaches outlined in this paper be realized in clinical practice, the devastating death toll caused by this condition could be reduced," said Dr. Black. About the Authors This position paper was written by three experts in the field, two internists from the American Society of Hypertension, Marshall D. Lindheimer, M.D. and Sandra J. Taler, M.D. and one obstetrician, F. Gary Cunningham, M.D., also the editor-in-chief of William's Obstetrics, a classic text for obstetricians. In addition, the American Society of Hypertension sought and incorporated review advice from the American College of Obstetricians and Gynecologists (ACOG). Position papers are used by medical organizations to make public the official recommendations and opinions of the group, and serve to enable discussion among physicians and the larger healthcare community. They do not represent official guidelines. About the American Society of HypertensionThe American Society of Hypertension (ASH) is the largest U.S. professional organization of scientific investigators and health care professionals committed to eliminating hypertension and its consequences. The Society serves as a scientific forum that bridges current hypertension research with effective clinical treatment strategies for patients. The mission of the organization is to promote strategies to prevent hypertension and to improve the care of patients with hypertension and associated disorders. For more information, please visit www.ash-us.org. About The Journal of the American Society of HypertensionThe Journal of the American Society of Hypertension (JASH), published by Elsevier, provides peer-reviewed articles on the topics of basic, applied and translational research on blood pressure, hypertension and related cardiovascular, vascular and renal disorders and factors. By focusing on both fundamental and applied research, this official journal serves as a complement to the Journal of Clinical Hypertension (JCH) and is distributed bi-monthly to approximately 5,000 physicians in the United States.