The effect of antihypertensive treatment on longitudinal changes in PLGF and sFlt-1 in women with new onset hypertension in pregnancy.

Abstract

To assess longitudinal changes in serum sFlt-1 and PLGF in women with newly diagnosed hypertension in pregnancy before and after commencing antihypertensive therapy, aiming at tight BP control (<135/85 mmHg).This was a prospective study that assessed women at presentation with hypertension and after 1 and 2 weeks of antihypertensive therapy. At each visit, blood pressure (BP) and blood tests to obtain levels of sFlt-1 and PLGF were taken. A multilevel linear mixed-effects model was performed to compare the repeated measurements of sFlt-1 and PLGF, controlling for maternal demographics, diagnosis at presentation, and antihypertensive agent used. The cohort was further subdivided into two groups based on how quickly they achieved target BP control to assess whether the degree of initial control influenced the angiogenic profile. Group 1 achieved BP < 135/85 after 1 week, while group 2 after 2 weeks of treatment.A total of 133 women were recruited into the study, 47 in group 1 and 86 in group 2. For the total cohort, both systolic blood pressure (SBP) and diastolic blood pressure (DBP) dropped after 1 week on antihypertensive medication (p < 0.001) and remained stable thereafter. LogPLGF demonstrated a continuous fall (p < 0.001) while LogsFlt-1 did not change after 1 and 2 weeks on medication. Group 1 had persistently higher LogPLGF than group 2 (p = 0.015). Both groups showed a reduction in LogPLGF at a similar rate over 2 weeks on antihypertensive medication. There was no difference between groups throughout the study in LogsFlt-1 and no change over time. There was a significant interaction between groups for SBP and DBP (p < 0.001) but no interaction between groups for LogPLGF or Log sFlt-1.In pregnant women with new-onset hypertension, tight BP control leads to a reduction in SBP and DBP within the first week of antihypertensive treatment. LogPLGF declines, but LogsFlt-1 shows no change with time. Women who achieved BP control within 1 week, compared to 2 weeks from commencing treatment, had higher LogPLGF but no difference in Log sFlt-1. Both groups demonstrated similar changes, with LogPLGF declining but LogsFlt-1 remaining static with time.