Differential effects of renin-angiotensine-aldosteron system inhibition, sympathoinhibition and low sodium diet on blood pressure in women with a history of preeclampsia: A double-blind, placebo-controlled cross-over trial (the PALM study)

•There was no effect of blood pressure lowering strategy on 24-hour blood pressure.•Nocturnal dipping was lower on RAAS inhibition compared and low sodium diet.•Low participation rate and large variability limit our conclusion.•Optimal antihypertensive strategy after preeclampsia should be further e...

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Bibliographic Details
Published in:Pregnancy hypertension 2022-03, Vol.27, p.173-175
Main Authors: Zoet, Gerbrand A., Paauw, Nina D., Veerbeek, Jan H.W., Groenhof, T. Katrien J., Spiering, Wilko, Verhaar, Marianne C., Franx, A., Titia Lely, A.
Format: Article
Language:English
Subjects:
Adult
Angiotensin II Type 1 Receptor Blockers - administration & dosage
Blood Pressure
Cardiovascular Diseases - prevention & control
Cross-Over Studies
Cross-over trial
Dietary Approaches To Stop Hypertension - methods
Double-Blind Method
Female
Gestational Age
Humans
Hypertension
Imidazoles - administration & dosage
Losartan - administration & dosage
Low sodium diet
Postpartum
Postpartum Period
Pre-Eclampsia - diet therapy
Pre-Eclampsia - drug therapy
Preeclampsia
Pregnancy
Renin-Angiotensin System - drug effects
Renin-angiotensin-aldosterone system inhibition
Sympathoinhibition
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Summary:•There was no effect of blood pressure lowering strategy on 24-hour blood pressure.•Nocturnal dipping was lower on RAAS inhibition compared and low sodium diet.•Low participation rate and large variability limit our conclusion.•Optimal antihypertensive strategy after preeclampsia should be further explored. Current guidelines lack sufficient evidence to recommend a specific blood pressure lowering strategy to prevent cardiovascular disease after preeclampsia. We conducted a double-blind cross-over trial to identify the most potent antihypertensive strategy: renin-angiotensin-aldosterone system (RAAS) inhibition (losartan), sympathoinhibition (moxonidine), low sodium diet and placebo (n = 10). Due to low inclusion rate our study stopped prematurely. Initiatory analyses showed no significant effect of antihypertensive strategy on office blood pressure and 24-hour blood pressure. However, nocturnal dipping was significantly higher on RAAS inhibition and low sodium diet compared to placebo and sympathoinhibition. Optimal cardiovascular prevention after preeclampsia should be further explored.
ISSN:2210-7789
2210-7797
DOI:10.1016/j.preghy.2021.12.016