Hypertensive disorders of pregnancy: observations on cardiovascular pathophysiology

Castleman, James Stephen (2020). Hypertensive disorders of pregnancy: observations on cardiovascular pathophysiology. University of Birmingham. M.D.

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Abstract

Hypertension affects one in ten pregnancies and its sequelae can affect women and their offspring in later life. The placenta has been the focus of much of the research into the pathogenesis of hypertension in pregnancy. A functioning placenta requires a functioning cardiovascular system, hence investigating whether concepts from hypertension research (echocardiographic structure and function, altered ventricular and arterial elastance and monocyte biology) apply to pregnancy hypertension is of great interest. Evidence for cardiovascular changes in hypertensive disorders of pregnancy is mounting, but the adaptations in subsequent pregnancy are unclear. The aim of this study was to compare cardiovascular (patho)physiology in pregnant women with and without previous hypertension in pregnancy. Monocyte subset heterogeneity was studied to provide mechanistic insight. Prospective changes in study parameters were analysed in each trimester of pregnancy and healthy non-pregnant women were studied as a control group at baseline. I found more prehypertension and increased arterial stiffness in pregnant women with prior hypertension and a corresponding increase in the CD14++CD16–CCR2+ (Mon1) and CD14+CD16++CCR2– (Mon3) monocyte subsets and their aggregates with platelets in these women. Changes in cardiovascular performance and their relationship to monocyte subsets may potentially be mechanisms leading to increased long-term cardiovascular risk.

Type of Work:

Thesis (Doctorates > M.D.)

Award Type:

Doctorates > M.D.

Supervisor(s):