Additive effects of mean blood pressure and bilateral notching in the second trimester on subsequent angiogenesis-related factors.

It has not been clarified whether high mean blood pressure (HBP) of ≥90 mm Hg and bilateral notching (BN) on uterine artery Doppler additively affect the subsequent circulating levels of placental growth factor (PlGF), soluble fms-like tyrosine kinase 1 (sFlt-1) and soluble endoglin (sEng). Serum levels of PlGF, sFlt-1 and sEng at 17-25 weeks and 26-32 weeks were measured in all women with HBP+BN- (n=272), HBP-BN+ (n=130) and HBP+BN+ (n=60) in 1239 eligible women, and 338 consecutive women with HBP-BN- were selected from the remaining 777 women. Only data before the onset of preeclampsia were evaluated. The cutoff value of an abnormal decrease of PlGF was set at the 5th percentile, and those of an abnormal increase of sFlt-1, sFlt-1/PlGF and sEng were set at the 95th percentile. The frequency of HBP in those with BN- was almost the same as that in those with BN+ (25.9% vs. 26.7%). In women with HBP-BN-, HBP-BN+, HBP+BN- and HBP+BN+, the frequency of abnormal sFlt-1/PlGF ratio at 26-32 weeks was 6.6%, 9.2%, 14.4% and 22.8%, respectively; and the frequency of abnormal sFlt-1/PlGF ratio at 26-32 weeks in those with HBP+BN+ was significantly increased than in HBP-BN-. Similarly, in the four groups, the frequency of abnormal sEng at 26-32 weeks was 5.4%, 2.5%, 12.2% and 19.0%, respectively; and the frequency in those with HBP+BN+ was significantly increased than in HBP-BN-. In conclusion, high BP levels and abnormal uterine artery Doppler may be additively implicated in circulating abnormalities of angiogenesis-related factors.