Asian women have attenuated sympathetic activation but enhanced renal-adrenal responses during pregnancy compared to Caucasian women

作者：Okada Yoshiyuki; Best Stuart A; Jarvis Sara S; Shibata Shigeki; Parker Rosemary S; Casey Brian M; Levine Benjamin D; Fu Qi^*

来源：The Journal of Physiology, 2015, 593(5): 1159-1168.

DOI：10.1113/jphysiol.2014.282277

Key points Asian women have a lower prevalence of hypertensive disorders of pregnancy than Caucasian women. This is the first longitudinal study to investigate neural and humoral responses during pregnancy in Asians and Caucasians. The key finding was that Asians had attenuated sympathetic activation but enhanced renal-adrenal responsiveness during pregnancy compared to Caucasians. These results may provide insights into the pathophysiological mechanisms for racial differences in the prevalence of hypertensive disorders during pregnancy.
AbstractAsians have a lower prevalence of hypertensive disorders of pregnancy than Caucasians. Since sympathetic overactivity and dysregulation of the renal-adrenal system (e.g. low aldosterone levels) have been found in preeclamptic women, we hypothesized that Asians have lower muscle sympathetic nerve activity (MSNA) and greater aldosterone concentrations during normal pregnancy than Caucasians. In a prospective study, blood pressure (BP), heart rate (HR), and MSNA were measured during supine and upright tilt (30deg and 60deg for 5min each) in 9 Asians (32 +/- 1years (mean +/- SEM)) and 12 Caucasians (29 +/- 1years) during pre-, early (8weeks of gestation) and late (32-36weeks) pregnancy, and post-partum (6-10weeks after delivery). Supine MSNA increased with pregnancy in both groups (P<0.001); it was significantly lower in Asians than Caucasians (14 +/- 3 vs. 23 +/- 3burstsmin(-1) and 16 +/- 5 vs. 30 +/- 3burstsmin(-1) in early and late pregnancy, respectively; P=0.023). BP decreased during early pregnancy (P<0.001), but was restored during late pregnancy. HR increased during pregnancy (P<0.001) with no racial difference (P=0.758). MSNA increased during tilting and it was markedly lower in Asians than Caucasians in late pregnancy (31 +/- 6 vs. 49 +/- 3burstsmin(-1) at 60deg tilt; P=0.003). Upright BP was lower in Asians, even in pre-pregnancy (P=0.006), and this racial difference persisted during pregnancy. Direct renin and aldosterone increased during pregnancy (both P<0.001); these hormones were greater in Asians (P=0.086 and P=0.014). Thus, Asians have less sympathetic activation but more upregulated renal-adrenal responses than Caucasians during pregnancy. These results may explain, at least in part, why Asian women are at low risk of hypertensive disorders in pregnancy.

• 出版日期2015-3-1