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Rom J Intern Med. 2012 Jan-Mar;50(1):71-81.

Pregnancy-induced hypertension--a particular pathogenic model. Similarities with other forms of arterial hypertension.

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University of Medicine and Pharmacy, Emergency County Hospital, Timi┼čoara, Romania.


Hypertension is in 85 to 90% of cases of unknown etiology, in spite of efforts undertaken by modern medicine to elucidate it. Numerous experimental studies were conducted in order to explain the pathogeny of this disease. Recent observations revealed that during therapy with anti-VEGF medication,used in treating different forms of cancer, hypertension and proteinuria occur, and at kidney level endothelial injuries appear similar to pregnancy-related hypertension. Antiangiogenic factors, such as sFlt-1, are produced during pregnancy-induced hypertension, especially in preeclampsia. They block the circulating VEGF. Consequently, proteinuria, and sometimes oedema occur together with hypertension. Renal injuries are of glomerular endotheliosis type. It is appreciated that one can draw a parallel between these pathologic situations, as is ablative treatment of antiangiogenic medication (anti-VEGF) and pregnancy-induced hypertension, preeclampsia, respectively. Since in pregnancy-induced hypertension angiogenic factors have an important role, we analyse their implication in other types of hypertension, in myocardial infarction, and in endothelial dysfunction in the course of CKD. The main pathogenic mechanism of pregnancy-induced hypertension that causes the disease is placental ischaemia. This is followed by the placental release of pressor substances that are involved both in generalised endotheliosis that characterizes the disease, and in hypertension. The prototype hypertension caused by renal ischaemia is renal artery stenosis. Both pregnancy-induced hypertension and hypertension in renal artery stenosis have a similar factor in their pathogeny, that is organ ischaemia with production of consecutive pressor substances. Since this ischaemic factor can intervene in other forms of hypertension, its characterisation becomes of importance at present. Thus, pregnancy-induced hypertension in pregnancy can represent a real pathogenic model of hypertension that is reflected in non-pregnancy hypertension. The paper presents the particularities of pregnancy-induced hypertension, as well as its parallelism with other types of hypertension that are determined by organ ischaemia or that produce ablation of angiogenic factors.

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