222. Differential effects of RAAS inhibition, sympatheticinhibition and low sodium diet on blood pressure in women with a history of preeclampsia

Introduction Current guidelines for prevention of cardiovascular disease after preeclampsia lack sufficient evidence to recommend a particular blood pressure lowering strategy. Objective To investigate the most effective blood pressure lowering strategy in women with a history of preeclampsia with postpartum (borderline) hypertension. Methods Randomized, four-way, double-blind, crossover study in 8 women with a history of preeclampsia with diastolic blood pressure >80 mmHg and/or systolic blood pressure >120 mmHg (PALM-study, NTR4590). In each woman the effects of 8 weeks of renin-angiotensin-aldosterone system (RAAS) inhibition (losartan 100 mg), sympatheticinhibition (moxonidine 0.4 mg), low sodium diet (50 mmol NaCl/24 h) and placebo on 24-h blood pressure were determined. Nocturnal dipping was assessed as non-dipping is associated with increased cardiovascular risk. Data were analyzed using linear mixed models with subject*visit as random factor. Results No significant effect of blood pressure lowering strategy was observed on 24-h blood pressure, although a trend towards lower mean arterial blood pressure was observed on losartan (92 ± 7 mmHg) and low sodium diet (94 ± 14 mmHg) compared to placebo (97 ± 13 mmHg) and moxonidine (98 ± 13 mmHg). Nocturnal dipping of mean arterial blood pressure did significantly differ ( p strategy = 0.03), with increased dipping on low sodium diet (−18 ± 9 mmHg, p = 0.01) and losartan (−18 ± 5 mmHg, p 0.01), compared to placebo (−13 ± 3 mmHg) and moxonidine (−6 ± 6 mmHg). On moxonidine compliance was lowest and one patient needed to terminate the treatment prematurely because of side-effects. Discussion Equal beneficial effects of RAAS inhibition and low sodium diet were observed on 24-h blood pressure, especially on nocturnal dipping, in women with a history of preeclampsia. These findings fit with the previously reported increased salt-sensitivity and disturbances in RAAS after preeclampsia.