Postnatal Enalapril to Improve Cardiovascular Function Following Preterm Preeclampsia (PICk-UP):: A Randomized Double-Blind Placebo-Controlled Feasibility Trial.
Postnatal Enalapril to Improve Cardiovascular Function Following Preterm Preeclampsia (PICk-UP):: A Randomized Double-Blind Placebo-Controlled Feasibility Trial.
复制标题
DOI：
10.1161/hypertensionaha.120.15875
复制
发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Myers JE
中科院分区：
文献类型：
--
作者：
Ormesher L;Higson S;Luckie M;Roberts SA;Glossop H;Trafford A;Cottrell E;Johnstone ED;Myers JE
妊娠期高血压疾病与未来的心血管疾病（CVD）有关，因此提供了一个机会，以确定哪些妇女可以从旨在降低心血管疾病发病率的有针对性的干预措施中受益。这项研究的重点是最高风险的群体，患有早产先兆子痫的妇女，他们未来死于CVD的风险是8倍。我们进行了一项单中心可行性随机对照试验（RCT），用依那普利治疗6个月以改善产后心血管功能。超声心动图和血流动力学测量进行了基线（< 3天），6周和6个月后分娩的60名妇女。随机分组时，88%的女性患有舒张功能障碍，68%的女性患有向心性重塑/肥大。6个月时，两组之间的总血管阻力（p=0.59）或收缩功能（总体纵向应变：p=0.14）无差异。然而，与安慰剂相比，接受依那普利治疗的女性在6个月时的超声心动图测量结果与改善的舒张功能（E/E '：p=0.04）和左心室（LV）重塑（相对壁厚：p=0.01; LV质量指数：p=0.03）一致。依那普利组在6周和6个月时分别有85%和63%的女性尿中检测到依那普利。所有妇女对将来服用依那普利反应积极。我们的研究证实了研究方案的可接受性和可行性，招募完成率为每月2.2名妇女。重要的是，出生后依那普利治疗与改善超声心动图测量相关;这些早期改善有可能降低长期CVD风险。现在需要一个明确的多中心随机对照试验来证实这些发现。
Hypertensive disease in pregnancy is associated with future cardiovascular disease (CVD) and therefore provides an opportunity to identify women who could benefit from targeted interventions aimed at reducing cardiovascular morbidity. This study focused on the highest-risk group, women with preterm preeclampsia, who have an 8-fold risk of death from future CVD. We performed a single-centre feasibility randomised controlled trial (RCT) of 6 months’ treatment with enalapril to improve postnatal cardiovascular function. Echocardiography and haemodynamic measurements were performed at baseline (< 3 days), 6 weeks and 6 months post-delivery on 60 women. At randomisation, 88% of women had diastolic dysfunction and 68% had concentric remodelling/hypertrophy. No difference was seen in total vascular resistance (p=0.59) or systolic function (global longitudinal strain: p=0.14) between groups at 6 months. However, women treated with enalapril had echocardiographic measurements consistent with improved diastolic function (E/E’: p=0.04) and left ventricular (LV) remodelling (relative wall thickness: p=0.01; LV mass index: p=0.03) at 6 months, compared with placebo. Urinary enalapril was detectable in 85% and 63% of women in the enalapril arm at 6 weeks and 6 months, respectively. All women responded positively to taking enalapril in the future. Our study confirmed acceptability and feasibility of the study protocol with a recruitment to completion rate of 2.2 women per month. Importantly, postnatal enalapril treatment was associated with improved echocardiographic measurements; these early improvements have the potential to reduce long-term CVD risk. A definitive, multi-centre RCT is now required to confirm these findings.