Maternal hemodynamics in hypertensive disorders of pregnancy

Hypertensive disorders of pregnancy (HDP) have been the leading cause of maternal and neonatal morbidity and mortality worldwide in the last decades. Recently, the common belief of preeclampsia (PE), defined as an increased blood pressure and organ dysfunction such as protein loss after 20 weeks of gestation, being a placental disorder was challenged. A number of studies reported short and long term cardiovascular changes in pregnancies affected by HDP suspecting a cardiovascular origin of the disease. Impaired cardiac output (CO), increased systemic vascular resistance and diastolic ventricular dysfunction- signs for impaired cardiac function- were detected by ultrasound evaluation of the maternal heart. Even though there are new insights into the origin of the disease, the concepts of therapy have not changed. Evidence for an improvement of antihypertensive therapy in women with HDP reflected by a decrease in adverse maternal and neonatal outcome is lacking. Therefore we aim to investigate maternal hemodynamics and cardiovascular parameters in women with HDP compared to a healthy pregnant control group matched for gestational age and in a preeclamptic rat model, with the special focus on changes in maternal hemodynamics due to antihypertensive treatment that has not been accessed in this specific setting before. In this prospective observational case control study over a three-year period we challenge the idea of blood pressure being the suitable target for antihypertensive therapy in women with HDP and aim to get new insights into the pathophysiology of the disease by using invasive procedures and assessing the structural morphology of the heart in our rat model.