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Factors Predisposing to Hypertension in Subjects Formerly Born Preterm: Renal Impairment, Arterial Stiffness, Endothelial Dyfunction or Something Else?

Author(s):

Antonio Crisafulli , Paolo Pier Bassareo *, Giuseppe Calcaterra , Sean Kelleher and Giuseppe Mercuro   Pages 1 - 9 ( 9 )

Abstract:


Subjects formerly born preterm subsequently develop arterial - particularly isolated systolic- hypertension more frequently than their peers born at term. Numerous factors may influence this predisposition, including an incomplete nephrogenesis, implying the presence of kidneys with a reduced number of nephrons and consequent reduction in haematic filtration, increased sodium absorption and activation of renin-angiotensin-aldosterone system, increased arterial rigidity produced by an elastin deficiency previously observed in anatomic specimens of human immature aorta, and reduced endothelial nitric oxide excretion, due to high blood levels of ADMA, a strong direct inhibitor of nitric oxide that exerts a vasoconstrictor effect. Other possible factors (i.e. excretion of neuroendocrine compounds) may also be implicated. The aim of this paper was to review all possible mechanisms involved in the observed increase in blood pressure in individuals who had been born preterm and/or with intrauterine growth restriction. The outlook for new and promising laboratory techniques capable of identifying alterations in the metabolic pathways regulating blood pressure levels, such as metabolomics, is also provided.

Keywords:

prematurity, preterm birth, low birth weight, blood pressure, hypertension, perinatal programming

Affiliation:

Department of Medical Sciences and Public Health, Sports Physiology Laboratory, University of Cagliari, Cagliari, University College of Dublin, Mater Misericordiae University Hospital and Our Lady�s Children`s Hospital Crumlin, Dublin, University of Palermo, Palermo, Our Lady`s Children`s Hospital Crumlin, Dublin, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari



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