Hemodynamically-Directed Atenolol Therapy is Associated with a Blunted Rise in Maternal sFLT-1 Levels During Pregnancy

Objective: Cardiac output and sFlt-1 are elevated prior to clinical evidence of preeclampsia. Early treatment of high cardiac output with atenolol decreases the risk for preeclampsia. We hypothesized that atenolol would impact circulating sFlt-1. Methods: Cardiac output and plasma sFlt-1 were measured 24 weeks' gestation and every 6 to 8 weeks in a longitudinal pilot study of: 1) women with risk factors for preeeclampsia (high-risk group; n = 46) who were treated with atenolol, and 2) low-risk group (control, n = 25) who were not treated. Results: The groups were similar in maternal age (meanSD: high-risk 28.3 5.4 versus control 30.3 5.5 years) and enrollment gestational age (17.3 4.3 versus 16.1 4.2 weeks). The high-risk group had higher cardiac output (9.7 1.7 versus 7.3 1.7 L/min; p 0.001) and mean arterial pressure (91.8 10.6 versus 79.6 7.3 mm Hg; p 0.001). Cardiac output and mean arterial pressure decreased while sFlt-1 levels rose less in the high-risk group compared with controls (p = 0.001 for all using GEE) even after adjusting for preeclampsia risk factors (age, weight, and primigravida status). Conclusion: Atenolol in high-risk women was associated with a lower rise in sFlt-1, suggesting an effect of hemodynamically directed treatment on the anti-angiogenic state.