Maternal wave reflections and arterial stiffness in normal pregnancy as assessed by applanation tonometry
Maternal wave reflections and arterial stiffness in normal pregnancy as assessed by applanation tonometry
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DOI：
10.1161/hypertensionaha.107.106062
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发表时间：
2008-04-01
期刊：
影响因子：
8.3
通讯作者：
Nicolaides, Kypros H.
中科院分区：
文献类型：
--
作者：
Macedo, Maria L.;Luminoso, Daniele;Nicolaides, Kypros H.
正常妊娠与母体心血管系统的深刻改变有关。本研究的目的是评估无创，使用压平血压计，产妇中央主动脉血压（BP），波反射和动脉硬度的影响（主动脉和臂脉波速度）在正常妊娠。这是一项横断面研究，包括193名怀孕11至41周的正常单胎妊娠妇女和23名年龄和身高相匹配的非妊娠对照。与未怀孕的对照组相比，孕妇的平均动脉压（85 +/- 8.9 mm Hg vs 81.1 +/- 7.2 mm Hg， P=0.01）、中央收缩压（103 +/- 11 mm Hg vs 96 +/- 8 mm Hg， P=0.001）、中央舒张压（71 +/- 9 mm Hg vs 67 +/- 7 mm Hg， P=0.008）和增强指数（AIx） （19 +/- 11% vs 4 +/- 12%， P=0.001）较低。在妊娠中期达到最低点时，AIx变化显著（R-2=0.05， P=0.007）。即使在调整了母亲年龄（P < 0.001）、心率（P < 0.001）和平均动脉血压（P < 0.001）后，这种变化仍然存在；AIx的已知决定因素。脉波速度（颈动脉-桡动脉和颈动脉-股动脉）在妊娠期间无显著变化，在妊娠期与非妊娠期无显著差异（颈动脉-桡动脉和颈动脉-股动脉分别P=0.03和P=0.05）。然而，调整母亲年龄和平均动脉压后，这些差异不显著（颈动脉-桡动脉P=0.2，颈动脉-股动脉P=0.5）。总之，我们发现正常妊娠与中央血压和波反射降低有关。
Normal pregnancy is associated with profound alterations in the maternal cardiovascular system. The aim of the present study was to assess noninvasively, using applanation tonometry, the maternal central aortic blood pressures (BP), effects of wave reflection and arterial stiffness (aortic and brachial pulse wave velocity) in normal pregnancy. This was a cross sectional study including 193 women with normal singleton pregnancies at 11 to 41 weeks of gestation and 23 nonpregnant controls, matched for age and height. Compared to nonpregnant controls, pregnant women had lower mean arterial pressure (85 +/- 8.9 mm Hg versus 81.1 +/- 7.2 mm Hg; P=0.01), central systolic BP (103 +/- 11 mm Hg versus 96 +/- 8 mm Hg, P=0.001), central diastolic BP (71 +/- 9 mm Hg versus 67 +/- 7 mm Hg, P=0.008), and augmentation index (AIx) (19 +/- 11% versus 4 +/- 12%, P=0.001). The AIx changed significantly with gestation reaching its nadir at midpregnancy (R-2=0.05, P=0.007). This change was present even after adjusting for maternal age (P < 0.001), heart rate (P < 0.001), and mean arterial BP (P < 0.001); known determinants of AIx. The pulse wave velocity (carotid-radial and carotid-femoral) did not change significantly with gestation and was marginally different between pregnant and nonpregnant women (P=0.03 and P=0.05 for carotid-radial and carotid-femoral respectively). However, adjustments for maternal age and mean arterial pressure rendered these differences nonsignificant (P=0.2 for carotid-radial, P=0.5 for carotid-femoral). In summary, we found that normal pregnancy is associated with a reduction in central BP and wave reflection.