The renin-aldosterone system in pre-eclampsia, essential and transient hypertension during pregnancy, and normotensive pregnant and non-pregnant control subjects

1982 ◽  
Vol 101 (2) ◽  
pp. 273-280 ◽  
Author(s):  
E. B. Pedersen ◽  
A. B. Rasmussen ◽  
P. Johannesen ◽  
H. J. Kornerup ◽  
S. Kristensen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Plasma Renin ◽  
Urinary Sodium Excretion ◽  
Third Trimester ◽  
Plasma Aldosterone Concentration ◽  
The Third ◽  
Control Subjects ◽  
Hypertension In Pregnancy ◽  
Normotensive Pregnancy ◽  
In Pregnancy

Abstract. Plasma renin concentration (PRC), plasma aldosterone concentration (PAC), and blood pressure were determined in the third trimester in pregnancy, 5 days and 6 months after delivery in pre-eclampsia, essential and transient hypertension in pregnancy and in normotensive pregnant and non-pregnant control subjects. PRC and PAC were elevated several fold above non-pregnant level in all groups during pregnancy. In pre-eclampsia PRC and PAC were 220 and 160%, respectively, above the levels 6 months after delivery, and thus lower than the corresponding values, 360 and 402%, in normotensive pregnancy. In essential and transient hypertension PRC and PAC increased to the same degree as during normotensive pregnancy. Urinary sodium excretion, serum sodium and creatinine clearance were reduced in pre-eclampsia, but not in essential and transient hypertension when compared to normotensive pregnant controls. All the parameters determined were the same as in non-pregnant controls 6 months after delivery in all groups. There were no correlations between blood pressure and PRC or PAC in any of the groups neither in pregnancy nor after delivery. It is concluded that the renin-aldosterone system is stimulated in lesser degree in pre-eclampsia than in both essential hypertension, transient hypertension and normotensive pregnancy, and there was no evidence for a causal relationship between the renin-aldosterone system and blood pressure neither in normotensive nor hypertensive pregnancy.

scholarly journals Plasma Aldosterone Concentration and Plasma Renin Activity Decrease during the Third Trimester in Women with Twin Pregnancies

2012 ◽  
Vol 31 (4) ◽  
pp. 419-426 ◽  
Author(s):  
Takahiro Koyama ◽  
Takashi Yamada ◽  
Itsuko Furuta ◽  
Mamoru Morikawa ◽  
Takahiro Yamada ◽  
...  
Keyword(s):  
Plasma Renin Activity ◽  
Plasma Renin ◽  
Plasma Aldosterone ◽  
Renin Activity ◽  
Third Trimester ◽  
Plasma Aldosterone Concentration ◽  
The Third ◽  
Twin Pregnancies ◽  
Activity Decrease

scholarly journals Alpha-Methyldopa-Induced Autoimmune Hemolytic Anemia in the Third Trimester of Pregnancy

2013 ◽  
Vol 2013 ◽  
pp. 1-2 ◽  
Author(s):  
Charalampos Grigoriadis ◽  
Aliki Tympa ◽  
Angelos Liapis ◽  
Dimitrios Hassiakos ◽  
Panagiotis Bakas
Keyword(s):  
Respiratory Failure ◽  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Diagnostic Procedure ◽  
Gestational Hypertension ◽  
Third Trimester ◽  
The Third ◽  
Hypertension In Pregnancy ◽  
Potential Risks ◽  
In Pregnancy

Alpha-methyldopa has been demonstrated to be safe for use during pregnancy and is now used to treat gestational hypertension. In pregnancy, alpha-methyldopa-induced autoimmune hemolytic anemia does not have typical features and the severity of symptoms ranges from mild fatigue to dyspnea, respiratory failure, and death if left untreated. A case of alpha-methyldopa-induced autoimmune hemolytic anemia in a 36-year-old gravida 2, para 1 woman at 37+6weeks of gestation is reported herein along with the differential diagnostic procedure and the potential risks to the mother and the fetus.

scholarly journals Hypertension in pregnancy

2006 ◽  
Vol 12 (1) ◽  
pp. 7-15 ◽  
Author(s):  
E. I. Baranova
Keyword(s):  
Antihypertensive Drugs ◽  
Gestational Hypertension ◽  
Developed Countries ◽  
Third Trimester ◽  
Pregnancy Hypertension ◽  
The Third ◽  
Hypertension In Pregnancy ◽  
In Pregnancy

In developed countries hypertension is observed in 6 - 15% of all pregnancies and occupies the second place in pregnancy morality rate after embolism. Hypertension can be dangerous not only for maternal but fetal deal h as well. Criteria for pregnancy hypertension are the same as general criteria ( ≥ 140 / ≥ 90 mm Hg). Hypertension in pregnancy is classified as following; preexisting hypertension, gestational hypertension, preeclampsia, mixed hypertension (preexisting and gestational). All antihypertensive drugs excluding methyldopa are contraindicated during the first and second trimesters, while several other drugs can be administrated during the third trimester.

scholarly journals Primary Hyperaldosteronism in Pregnancy: A Case Report

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A153-A154
Author(s):  
Jefferson Li ◽  
Alaa Kubbar ◽  
Eunice Kim ◽  
Dennis Nunez Pelaez ◽  
Giovanna Rodriguez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Aldosteronism ◽  
Cardiovascular Health ◽  
Normal Sinus Rhythm ◽  
Insulin Dose ◽  
Plasma Renin ◽  
Primary Hyperaldosteronism ◽  
Uncontrolled Hypertension ◽  
Plasma Aldosterone Concentration ◽  
In Pregnancy

Abstract Background: Primary aldosteronism (PA) is a renin-independent hypersecretion of aldosterone that remains an underdiagnosed etiology of hypertension. Less than 50 cases of primary hyperaldosteronism in pregnancy have been reported in literature that are associated with pregnancy complications including preeclampsia. Clinical Case: A 41-year-old female G9P4 at 32 weeks gestation was admitted for suspected preeclampsia due to elevated blood pressure during a routine prenatal visit. Her comorbidities include type 2 diabetes, uncontrolled hypertension, and preeclampsia in a previous pregnancy. Home medications included Lisinopril 10 mg once daily which was discontinued upon pregnancy and switched to Labetalol 400 mg twice daily and Nifedipine ER 30 mg daily. She was on a total of 220 units of insulin daily. On presentation, patient complained of anxiety but denied any headache, nausea, visual disturbances, chest pain, palpitations, muscle cramps, or fatigue. Her blood pressure was 180/100 mmHg with heat rate of 73. Laboratory values was notable for potassium: 2.8 mmol/L (n 3.5–5 mmol/L), bicarbonate: 28 mmol/L (n 24–31 mmol/L), and magnesium: 1.4 mEq/L (n 1.3–1.9 mEq/L). Liver function test and platelet count were normal. Spot protein-creatinine ratio was 0.3 (n 0–0.2). ECG was normal sinus rhythm with a heart rate of 82 without decreased T wave amplitude or U waves. She received three doses of oral 40 mEq potassium chloride over twelve hours and potassium level post repletion was 3.0 mmol/L. Initially, her hypokalemia was attributed to high insulin dose requirements. Despite down titration of insulin, patient continued to have hypokalemic episodes (nadir 2.7 mmol/L) refractory to oral and parenteral potassium supplementation. She remained hypertensive despite Labetalol 600 mg every 8 hours, Nifedipine ER 30 mg every 12 hours, with as needed hydralazine 10 mg IV pushes, and underwent urgent cesarean delivery. Uncontrolled hypertension persisted postpartum with recurrent episodes of hypokalemia. Further investigations revealed a plasma aldosterone concentration (PAC) and plasma renin activity (PRA) levels of 43.5 ng/dL (n <10 ng/dL) and 1.67 ng/mL/hr (n 0.17–5.38 ng/mL/hr) respectively, potassium at time of testing was 3.6 mmol/L. PAC to PRA ratio was greater than 20:1 with an absolute PAC greater than 15 ng/dL, which is highly suggestive of PA. Conclusion: We present a case of suspected PA with spontaneous hypokalemia potentially masked by the use of ACE inhibitors uncovered during pregnancy. Given the changes to the renin-angiotensin-aldosterone system (RAAS) during pregnancy, the diagnosis of PA is difficult to establish during gestation. Still, little is known on how to optimally treat these patients. Reference: Morton, A., 2015. Primary Aldosteronism and Pregnancy. Pregnancy and hypertension. An International Journal of Women’s Cardiovascular Health, Volume 5 Issue 4, 259–262.

Plasma noradrenaline and adrenaline in pre-eclampsia, essential hypertension in pregnancy and normotensive pregnant control subjects

1982 ◽  
Vol 99 (4) ◽  
pp. 594-600 ◽  
Author(s):  
E. B. Pedersen ◽  
A. B. Rasmussen ◽  
N.J. Christensen ◽  
P. Johannesen ◽  
J. G. Lauritsen ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Plasma Catecholamines ◽  
Plasma Noradrenaline ◽  
Third Trimester ◽  
Control Subjects ◽  
Hypertension In Pregnancy ◽  
Adrenergic Activity ◽  
Noradrenaline And Adrenaline ◽  
In Pregnancy ◽  
Normotensive Control

Abstract. Noradrenaline and adrenaline in plasma were determined in 15 patients with pre-eclampsia, 10 pregnant patients with essential hypertension, 2 patients with transient hypertension in pregnancy, 11 normotensive pregnant control subjects, and 16 non-pregnant normotensive control subjects. Measurements were performed in the second and third trimester, 5 days, and 3 months after delivery. Comparison within groups showed no significant differences in plasma noradrenaline or adrenaline between levels in pregnancy, 5 days after delivery, and 3 months after delivery in neither pre-eclampsia, essential hypertension nor normotensive pregnant control subjects. Comparison between groups showed no significant differences between the levels in pre-eclampsia, essential hypertension and normotensive pregnant control subjects, neither in pregnancy nor after delivery. Plasma noradrenaline and adrenaline in pregnancy were the same as in normotensive non-pregnant control subjects. Plasma noradrenaline and blood pressure were not correlated in any of the groups. It is concluded that the sympathetic adrenergic activity evaluated by plasma catecholamines is normal in patients with pre-eclampsia and pregnant patients with essential hypertension.

The Renin-Aldosterone System in Exaggerated Natriuresis of Essential Hypertension

1977 ◽  
Vol 53 (6) ◽  
pp. 573-578 ◽  
Author(s):  
E. B. Pedersen ◽  
H. J. Kornerup
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Sodium Excretion ◽  
Plasma Renin ◽  
Urinary Sodium Excretion ◽  
Plasma Aldosterone ◽  
Urinary Sodium ◽  
Mean Blood Pressure ◽  
Plasma Aldosterone Concentration ◽  
Plasma Renin Concentration

1. The effect of intravenous loading with 500 ml of sodium chloride solution (50 g/l) on plasma renin concentration, plasma aldosterone concentration, urinary sodium excretion and mean blood pressure was studied in 15 young patients with mild essential hypertension and 10 healthy normotensive control subjects. 2. Plasma renin concentration and plasma aldosterone concentration were suppressed to the same degree during loading in both the hypertensive and normotensive groups. Urinary sodium excretion was significantly higher in the hypertensive patients than in the normotensive subjects. Mean blood pressure increased slightly in both groups. 3. Plasma renin concentration and plasma aldosterone concentration were significantly correlated in both groups before sodium loading. The increase in urinary sodium excretion was significantly correlated to the suppression of plasma aldosterone concentration in the hypertensive, but not in the normotensive, group. No correlation was found between changes in urinary sodium excretion and changes in plasma renin concentration or mean blood pressure. 4. The results indicate that the suppressibility of the renin—aldosterone system by hyperosmotic sodium chloride solution is normal in young patients with mild essential hypertension. It is suggested that the changes in plasma aldosterone concentration induced by sodium loading might be involved in the regulation of exaggerated natriuresis in essential hypertension.

Hypertension Secondary to Ingestion of Licorice Root Tea

2011 ◽  
Vol 27 (6) ◽  
pp. 266-268 ◽  
Author(s):  
Tony Joseph Eid ◽  
Amanda A Morris ◽  
Sachin A Shah
Keyword(s):  
Blood Pressure ◽  
Dietary Supplements ◽  
Blood Pressure Measurement ◽  
Plasma Renin ◽  
Licorice Root ◽  
African American Female ◽  
Lifestyle Modifications ◽  
Plasma Aldosterone Concentration ◽  
Serum Potassium Concentration ◽  
The Impact

Objective: To report a case of hypertension secondary to ingestion of licorice root tea. Case Summary: A 46-year-old African American female with newly diagnosed stage 1 hypertension presented with a blood pressure measurement of 144/81 mm Hg and a reduced plasma potassium level of 3.2 mEq/L. The patient attempted lifestyle modifications prior to initiating an antihypertensive agent, but at a follow-up appointment, her blood pressure remained elevated. A current laboratory panel revealed a depressed morning plasma aldosterone concentration (PAC) of 5 ng/dL and low morning plasma renin activity (PRA) of 0.13 ng/mL/h. Later it was revealed that the patient regularly (1–2 cups/day) consumed “Yogi Calming” tea, a blend of herbs, including licorice root. The patient was advised to discontinue consumption of the herbal tea, and at a subsequent appointment, her blood pressure was 128/73 mm Hg and her laboratory panel had improved, including serum potassium concentration of 4.1 mEq/L, PAC of 6 ng/dL, and PRA of 0.19 ng/mL/h. Discussion: Excessive consumption of licorice has been well documented to cause pseudohyperaldosteronism, characterized by hypertension, hypokalemia, and suppressed plasma renin and aldosterone levels. Glycyrrhizin, the active ingredient in licorice, inhibits 11β-hydroxysteroid dehydrogenase type 2, an oxidase responsible for the conversion and inactivation of cortisol to cortisone. Chronic ingestion of licorice-containing foods has been demonstrated to cause pseudohyperaldosteronism. These include soft candies, lozenges, and dietary supplements, but licorice-containing teas have been infrequently described. Based on the Naranjo probability score, our patient's hypertension appears to have been a probable licorice-induced reaction secondary to a licorice-containing tea. Conclusions: Herbal and dietary supplements are frequently consumed by patients without full knowledge of the contents of the products or the impact on their health. In clinical practice, when hypertension is accompanied by hypokalemia and reduced PRA and PAC, licorice consumption should be investigated and causal hypertension ruled out.

Hypertensive Disorders in Pregnancy

2017 ◽  
Author(s):  
Kavitha Vellanki ◽  
Susan Hou
Keyword(s):  
Blood Pressure ◽  
Organ Damage ◽  
The United States ◽  
Blood Pressure Target ◽  
Maternal Complications ◽  
Hypertension In Pregnancy ◽  
Hypertensive Disorders ◽  
Few Data ◽  
In Pregnancy ◽  
New Onset

Hypertensive disorders are the second leading cause of maternal mortality in the United States. Hypertension in pregnancy is defined as blood pressure greater than or equal to 140 mm Hg systolic or greater than or equal to 90 mm Hg diastolic, measured on at least two separate occasions. Preeclampsia, as per the new guidelines, is characterized by the new onset of hypertension and either proteinuria or other end-organ dysfunction, more often after 20 weeks of gestation in a previously normotensive pregnant woman. New-onset proteinuria is not required for diagnosis of preeclampsia if there is evidence of other end-organ damage—a change from previous classifications. Although no screening test has yet proven accurate enough to predict preeclampsia, the use of a combination of the serologic factors seems promising. There are few data to support any specific blood pressure target in pregnancy. Although there is a general consensus on treating severe hypertension in pregnancy, there is a difference of opinion on treating mild to moderate hypertension in pregnancy. Avoiding uteroplacental ischemia and minimizing fetal exposure to adverse effects of medications are as important as avoiding maternal complications from high blood pressure during pregnancy. This review contains 2 figures, 4 tables, and 73 references.

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