Hypertension in pregnancy: a danger for now and later

Abstract

Objective. Hypertension in pregnancy presents as a syndrome with several phenotypic forms which variously affect a variety of organs, such as the vascular endothelium, blood pressure control, the coagulation system, renal glomeruli and the placenta. Through a number of studies, it has been documented that there is a common familial form. Several genetic defects have been associated with expression of the disease in these families. The syndrome may cause or be pan of a pathophysiological mechanism that leads to an increased chance of cardiovascular disease in later life.

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Method. A review will be given of published studies on familial hypertension in pregnancy, on inheritance mechanisms and on the current knowledge on genetic aberrations as well as on links to later cardiovascular complications in women.

Results. There is a definitive familial tendency. The likely inheritance mode is multifactorial and/or through a major gene defect with an approximately 30% penetration. This evokes increased susceptibility to the disease. Seemingly sporadic cases may have a familial origin as inheritance can occur through sons as well as daughters and may thus skip generations. Gene aberrations linked to or associated with the disease include the genes encoding for angiotensinogen (perhaps different Significance for eclampsia and preeclampsia}, endothelial nitric oxide synthase and genes on chromosomes 2, 4 and 9, as well as some specific rare familial forms with other genetic links. There is a raised risk ratio for cardiovascular disease in later life, particularly coronary artery disease.

Conclusions: Hypertension in pregnancy is a multisystem syndrome which often occurs in families, has a couple of likely inheritance modes, has been linked to genetic aberrations and some of the phenotypes will be related to a raised risk of cardiovascular illness or death in later life.