Fernandez-Castro Isabel, Vazquez-Agra Nestor, Alban-Salgado Ana, Sanchez-Andrade Mariña, Lopez-Casal Susana, Cruces-Sande Anton, Seoane-Casqueiro Oscar, Pose-Reino Antonio, Hermida-Ameijeiras Alvaro
Department of Internal Medicine, University Hospital Complex of Vigo, 36312 Vigo, Pontevedra, Spain.
Department of Internal Medicine, University Clinical Hospital of Santiago de Compostela, 15706 Santiago de Compostela, A Coruña, Spain.
Int J Mol Sci. 2025 Jun 25;26(13):6115. doi: 10.3390/ijms26136115.
Uncomplicated hypertension (UH) during pregnancy represents a common condition, worsening maternal and fetal prognosis. However, no single biomarker has proven optimal for determining the risk of UH. We developed an early risk multivariate model for UH, integrating hemodynamics with biochemistry, focusing on the relationship between blood pressure (BP) indices, uric acid (UA), and angiogenesis-related factors (AF). We collected and analyzed data on 24 h ambulatory BP monitoring, demographic, epidemiological, clinical, and laboratory variables from 132 pregnancies. The main predictors were BP indices and serum UA and AF levels. Uncomplicated hypertension, defined as the presence of gestational hypertension or worsening of essential hypertension beyond the 20th week, was the main outcome. The combined second-degree polynomial transformation of UA and the AF (sFlt-1/PIGF) ratio, called the UA-AF Index, consistently showed a positive association with UH. The models incorporating nighttime BP indices combined with the UA-AF Index outperformed the others, with the best-performing model based on the nocturnal systolic BP (SBP). Specifically, in the best-fitting model (nighttime SBP + UA-AF Index as predictors), each 1 mmHg increase in nocturnal SBP was associated with a 10% higher risk of UH, while each one-unit increase in the UA-AF Index raised the likelihood of UH by more than twofold (accuracy: 0.830, AUC 0. 874, SE 0.032, -value < 0.001, 95%CI 0.811-0.938). The combination of nighttime blood pressure indices, serum uric acid, and angiogenesis-related factors may provide added value in the assessment of uncomplicated hypertension during pregnancy.
妊娠期单纯性高血压（UH）是一种常见病症，会使母婴预后恶化。然而，尚未有单一生物标志物被证明是确定UH风险的最佳指标。我们开发了一种UH早期风险多变量模型，将血流动力学与生物化学相结合，重点关注血压（BP）指标、尿酸（UA）和血管生成相关因子（AF）之间的关系。我们收集并分析了132例妊娠的24小时动态血压监测、人口统计学、流行病学、临床和实验室变量数据。主要预测指标为BP指标、血清UA和AF水平。单纯性高血压定义为妊娠高血压的存在或原发性高血压在第20周后恶化，是主要结局。UA与AF（sFlt-1/PIGF）比值的联合二阶多项式变换，称为UA-AF指数，始终显示与UH呈正相关。纳入夜间BP指标与UA-AF指数的模型优于其他模型，表现最佳的模型基于夜间收缩压（SBP）。具体而言，在最佳拟合模型（夜间SBP + UA-AF指数作为预测指标）中，夜间SBP每升高1 mmHg，UH风险增加10%，而UA-AF指数每升高一个单位，UH的可能性增加两倍以上（准确率：0.830，AUC 0.874，SE 0.032，P值<0.001，95%CI 0.811 - 0.938）。夜间血压指标、血清尿酸和血管生成相关因子的组合可能在评估妊娠期单纯性高血压方面提供附加价值。
