Wiel, W.K. van der (2012) Nondipping and sodium sensitivity of bloodpressure in formerly pre-eclamptic women. thesis, Medicine.
Full text available on request.Abstract
Introduction: Healthy subjects exhibit a pronounced diurnal rhythm of blood pressure (BP), visualized by means of 24-hour ambulatory blood pressure monitoring (ABPM). A normal 24-hour BP pattern is characterized by a nocturnal decline of 10-20%. A nondipping BP pattern is regarded as abnormal and associated with increased cardiovascular risk and increased sodium sensitivity, which is a cardiovascular risk factor itself. A nondipping BP pattern is frequently seen in preeclamptic women during pregnancy. Absence of the nocturnal BP dip during preeclamptic pregnancy is associated with adverse maternal and fetal outcomes. In this study we examined the diurnal BP pattern postpartum in formerly preeclamptic women, and the influence of sodium intake. We hypothesized that increased sodium sensitivity is related to loss of nocturnal BP fall in formerly preeclamptic women. Methods and Procedures: This patient-control crossover study studied women after preeclampsia or normotensive pregnancy one to ten years after pregnancy. The study consisted of two dietary weeks: a week of low sodium intake (≤ 50 mmol/day) and a week of high sodium intake (≥ 200 mmol/day), both starting on the first day of menstruation. On day 5 of each dietary week ABPM was performed (Spacelabs model 90207). For each subject, day and nighttime period were defined by means of personal diaries, and mean systolic BP (SBP), diastolic BP (DBP) and heart rate (HR) were calculated. Results: Eight formerly preeclamptic and four formerly normotensive pregnant women were included. All subjects were normotensive, non-smokers and not suffering from diabetes mellitus. Six formerly preeclamptic and three formerly normotensive pregnant women completed both low and high sodium diet. Analyzing these nine subjects as a group revealed a higher SBP during high sodium intake compared with low sodium intake (p = 0.02). A negative correlation was found between this SBP response to sodium and nocturnal dipping (R = -0.83, p < 0.01). More nondippers were found in the group of formerly preeclamptic women compared with the healthy controls. Five out of eight formerly preeclamptic women had a reduced nocturnal BP fall during low sodium intake compared with one out of four in the control group (ns). Discussion: Our study reveals a trend towards more nondippers among formerly preeclamptic women compared with women after normotensive pregnancy. Furthermore, clear influence of sodium intake on 24-hour BP pattern is found. In a normotensive group consisting of both formerly preeclamptic women as well as women with no history of hypertensive disorder during pregnancy, increased BP values were found during high sodium intake with a decrease of nocturnal fall being associated with increased sodium sensitivity. This indicates increased cardiovascular risk during high sodium intake, even for normotensive women without a history of hypertensive disorder.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Lefrandt, J.D. MD and Department of Vascular Medicine University Medical Centre Gr and Lely, A.T. MD and Department of Obstetrics & Gynaecology and University Medical Centre Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:56 |
| Last Modified: | 25 Jun 2020 10:56 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1657 |
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