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First trimester angiogenic and inflammatory factors in women with chronic hypertension and impact of blood pressure control: a case-control study.
  • Diane Nzelu,
  • Kypros Nicolaides,
  • Nikos Kametas
Diane Nzelu

Corresponding Author:[email protected]

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Kypros Nicolaides
Fetal Medicine Institute
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Nikos Kametas
Kings College Hospital
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Objectives: Assess first trimester serum placental growth factor (PLGF), soluble fms-like tyrosine kinase-1 (sFLT-1), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), 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 4 groups. Group 1 included women without pre-pregnancy CH presenting with BP ≥140/90mmHg. Groups 2-4 had pre-pregnancy CH; in group 2 the BP was <140/90mmHg without antihypertensive medication, in group 3 the BP was <140/90mmHg with antihypertensive medication and in group 4 the BP was ≥ 140/90 mmHg despite antihypertensive medication. PLGF, sFLT-1, IL-6, TNF-α, endothelin and VCAM were measured at 11+0-13+6 weeks’ 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, IL-6, TNF-α, endothelin and VCAM between the 4 CH groups and the controls were made using analysis of variance or Kruskal-Wallis tests. Results: In the CH groups, compared to controls, PLGF was reduced in groups 2-4, sFLT-1 was reduced in groups 2 and 3, endothelin was increased in groups 1 and 4 but IL-6 was reduced in group 4. Conclusion: In women with CH, differences exist in first trimester angiogenic and inflammatory profiles according to BP control. Further evaluation is needed to determine if these differences are useful in the stratification of care.
10 Nov 2020Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
11 Nov 2020Submission Checks Completed
11 Nov 2020Assigned to Editor
13 Nov 2020Reviewer(s) Assigned
07 Dec 2020Review(s) Completed, Editorial Evaluation Pending
24 Dec 2020Editorial Decision: Revise Major
09 Feb 20211st Revision Received
10 Feb 2021Submission Checks Completed
10 Feb 2021Assigned to Editor
19 Feb 2021Reviewer(s) Assigned
09 Mar 2021Review(s) Completed, Editorial Evaluation Pending
03 Apr 2021Editorial Decision: Accept
Dec 2021Published in BJOG: An International Journal of Obstetrics & Gynaecology volume 128 issue 13 on pages 2171-2179. 10.1111/1471-0528.16835