First trimester angiogenic and inflammatory factors in women with chronic hypertension and impact of blood pressure control: a case-control study

Objectives To assess first trimester serum placental growth factor (PLGF), soluble fms-like tyrosine kinase-1 (sFLT-1), interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha), endothelin and vascular cell adhesion molecule (VCAM) in women with chronic hypertension (CH) stratified according to blood pressure (BP) control. Design Case-control. Setting Tertiary referral centre. Population 650 women with CH, 142 normotensive controls. Methods In the first trimester, patients with CH were subdivided into four groups. Group 1 included women without pre-pregnancy CH presenting with BP >= 140/90 mmHg. Groups 2-4 had pre-pregnancy CH; in group 2 the BP was <140/90 mmHg without antihypertensive medication, in group 3 the BP was <140/90 mmHg with antihypertensive medication, and in group 4 the BP was >= 140/90 mmHg despite antihypertensive medication. PLGF, sFLT-1, IL-6, TNF-alpha, endothelin and VCAM were measured at 11(+0)-13(+6) weeks' gestation and converted into multiples of the expected median (MoM) using multivariate regression analysis in the controls. Main outcome measure Comparisons of MoM values of PLGF, sFLT-1, endothelin, IL-6, TNF-alpha and VCAM between the entire cohort of women with CH and the control group were made using Student's t-test or Mann-Whitney U-test. Comparisons between the four CH groups were made using analysis of variance or Kruskal-Wallis tests. Results Compared with the control group, women with CH had significantly lower MoM of PLGF, sFLT-1 and IL-6 and a significantly higher MoM of endothelin. Between the four groups of women with CH, there were no significant differences in the MoM of sFLT-1, PLGF, sFLT-1/PLGF ratio, endothelin, IL-6 or VCAM, or in the levels of TNF-alpha. Conclusion In women with CH, differences exist in first trimester angiogenic and inflammatory profiles when compared with normotensive pregnancies. However, these differences do not assist in the stratification of women with CH to identify those with more severe underlying disease and worse pregnancy outcomes.

Automated summary

The study aimed to evaluate the levels of various angiogenic and inflammatory factors in the first trimester serum of women with chronic hypertension, finding differences compared to normotensive women. However, these differences did not help in identifying women with more severe underlying disease and worse pregnancy outcomes.