Abstract 16012: Increased Blood Pressure in Preterm-Born Individuals Correlates With a Distinct Antiangiogenic State and Microvascular Abnormalities in Adult Life
Introduction: Preterm-born individuals are found to have higher blood pressure and are two-fold more likely to have sought medical care and been diagnosed with hypertension sufficient to need medication by the age of 30 years.
Hypothesis: We hypothesized that elevated blood pressure in preterm-born young adults is associated with an enhanced antiangiogenic circulating blood profile, proportional to the degree of capillary rarefaction and independent of other associated cardiovascular measures.
Methods: We studied 204 adults at mean age 25 years, including 102 who had been followed prospectively since very preterm birth (mean gestational age 30.3±2.5 weeks) and 102 born at term to uncomplicated pregnancies. Levels of soluble endoglin (sENG) and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured using enzyme-linked immunosorbent assays (ELISAs) and compared between groups. It was then explored how these levels related to blood pressure and other cardiovascular risk factors. Associations between factors were then studied in a group of 30 preterm-born individuals who had undergone complete phenotyping with ambulatory blood pressure as well as microvascular, macrovascular and cardiac imaging.
Results: Preterm-born offspring have elevations in sENG (5.64±1.03 vs 4.06±0.85 ng/mL, P<0001) and sFlt-1 (88.1±19.0 vs 73.0±15.3 pg/mL, P<0.001) compared to term-born offspring, proportional to blood pressure and degree of prematurity (P<0.05). Being born to a preeclamptic pregnancy was associated with an additional increase in sFlt-1 (P=0.002). In the subgroup of preterm-born individuals, associations were similar with ambulatory blood pressure measures, and there was a graded association with degree of functional and structural capillary rarefaction (P=0.002 and P<0.001). Antiangiogenic factors were not associated with other cardiac or vascular measures.
Conclusions: This is the first demonstration of a heightened antiangiogenic state in later life in individuals who were born preterm. These findings implicate a link between an imbalance in proangiogenic and antiangiogenic factors, capillary rarefaction and elevated blood pressure in preterm-born young adults. This may represent a novel target for intervention.
Author Disclosures: A.J. Lewandowski: None. E.F. Davis: None. A. Singhal: None. A. Lucas: None. K. McCormick: None. A.C. Shore: None. P. Leeson: None.
- © 2014 by American Heart Association, Inc.