Article Review 5

Cerebral Perfusion Pressure In Women With Preeclampsia Is Elevated Even After Treatment Of Elevated Blood Pressure

Maternal deaths from preeclampsia occur mainly due to cerebral infarction and hemorrhage, possibly due to increased cerebral perfusion pressure (CPP). High CPP has been linked to preeclamptic symptoms and eclamptic seizures. Labetalol and MgSO4, drugs used to control hypertension in preeclamptic patients, cause a decrease in CPP, while another antihypertensive drug, nimodipine, causes CPP to increase. Nimodipine is associated with more eclamptic seizures, possibly due to the increase in CPP. The purpose of the study was to evaluate the CPP in preeclamptic women with blood pressure controlled by antihypertensives. The CPP was calculated using zero-flow pressure and mean arterial blood pressure measurements. The zero flow pressure, arterial blood pressure, CPP, and CFI were all higher in preeclamptic women than control women. Additionally, a correlation was found between mean arterial blood pressure and CPP in preeclamptic patients, but not in controls.

As cerebrovascular complications are the main cause of death to preeclamptic women, and preeclampsia affects 3-8% of all pregnancies, this study is relevant. The authors used two methods to calculate the CPP, and, in both cases, the CPP was higher for preeclamptic women. Additionally, the authors report that the CPP calculated for the control patients was similar to that reported in other studies, which shows consistency between studies. The authors did, however, use non-invasive methods to measure the CPP, which have not been validated in humans. Nevertheless, they got similar results with both calculations of CPP.

Future studies could include trials with additional or alternative antihypertensive medications to bring the CPP to normal levels along with the blood pressure. The effect of lower CPP on the risk of cerebrovascular complications can then be observed. Additionally, studies could be done to validate the techniques for non-invasive measurement of CPP in humans.

Sonneveld, Milan J., et al. “Cerebral Perfusion Pressure In Women With Preeclampsia Is       Elevated Even After Treatment Of Elevated Blood Pressure.” Acta Obstetricia Et Gynecologica Scandinavica 93.5 (2014): 508-511. Academic Search Complete. Web. 20 Oct. 2016.

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