74 Association of sympathovagal imbalance with endothelial dysfunction in South Indian women with risk for pregnancy-induced hypertension – A follow-up study from a tertiary care hospital

Abstract

Introduction Pregnancy-induced hypertension (PIH) is a serious medical complication with increasing incidence across the developing countries like India (5–15%). PIH is mainly characterised by widespread alteration and dysfunction in maternal vascular endothelium. But, whether the dysfunction is a cause or consequence of this multisystemic disorder has to be determined. Though the etiology of the disease is still indefinable, it is clear that it requires placenta to develop. Placental factors leads to extensive stimulation/dysfunction of the vascular endothelium, which in turn causes hypertension. The sympathetic activity is exaggerated in PIH even in the first trimester. Also sympathetic over activity plays a pathogenic role in stimulating hypertension and endothelial dysfunction. But so far no research have been conducted to explore the relationship between maternal endothelial factors and sympathovagal imbalance. Hence, in this study, we measured the degree of sympathetic activity and endothelial dysfunction in all the three trimesters to understand the causation of the disorder in pregnant women. Objective To study the association of sympathovagal imbalance (SVI) with endothelial dysfunction in pregnant women having a risk for PIH. Methods This is a prospective longitudinal study. Subjects were initially divided into 2 groups: Control group ( n = 50) and study group. Control group includes normotensive pregnant women and study group includes pregnant women with risk factors for PIH. Subjects were followed till term and incidence of PIH were noted. The study group was later sub-grouped into study group I (did not develop PIH, n = 45) and study group II (developed PIH, n = 40). Later retrospective analysis was done to understand the changes from early trimester. Cardiac autonomic function test which includes short-term heart rate variability, forced breathing test, orthostatic stress test and isometric handgrip test were performed. Arterial stiffness was measured using the non-invasive oscillometric device called PeriScope. Results LF–HF ratio of HRV, the sensitive indicator of SVI was significantly high ( p Conclusion Endothelial dysfunction are present in pregnant women having a risk factors for PIH even from the early trimester and SVI is linked to endothelial dysfunction in these subjects.