Renin-angiotensin system in pre-eclampsia: everything old is new again

JJ Spaan, MA Brown - Obstetric Medicine, 2012 - journals.sagepub.com
JJ Spaan, MA Brown
Obstetric Medicine, 2012journals.sagepub.com
This review presents an update of the role of the renin-angiotensin system in normal
pregnancy and pre-eclampsia. We have known for years that the circulatory renin-
angiotensin system in pre-eclampsia is suppressed. We now know that the circulating renin-
angiotensin system does not only have a vasoconstrictor arm, but also a vasodilator arm,
which is upregulated in normal pregnancy; this balance is probably disturbed in pre-
eclampsia. Recent studies show the importance of the local renin-angiotensin system in the …
This review presents an update of the role of the renin-angiotensin system in normal pregnancy and pre-eclampsia. We have known for years that the circulatory renin-angiotensin system in pre-eclampsia is suppressed. We now know that the circulating renin-angiotensin system does not only have a vasoconstrictor arm, but also a vasodilator arm, which is upregulated in normal pregnancy; this balance is probably disturbed in pre-eclampsia. Recent studies show the importance of the local renin-angiotensin system in the uteroplacental unit for early placentation and regulation of placental blood flow. We discuss the possible role of autoantibodies against the AT1-receptor in pre-eclampsia and the suggestion that activation of the AT1-receptor in the placenta may lead to placental dysfunction and the clinical syndrome of pre-eclampsia.
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