Factors Predisposing to Hypertension in Subjects Formerly Born Preterm: Renal Impairment, Arterial Stiffness,...

Area of Science:

• Cardiovascular Physiology
• Nephrology
• Developmental Pediatrics

Background:

• Individuals born preterm exhibit a higher incidence of arterial hypertension compared to term-born peers.
• This predisposition is linked to several physiological alterations originating during fetal development.

Purpose of the Study:

• To comprehensively review the multifactorial mechanisms underlying hypertension in individuals born preterm or with intrauterine growth restriction.
• To discuss emerging laboratory techniques for identifying metabolic alterations related to blood pressure regulation.

Main Methods:

• Literature review of studies investigating cardiovascular and renal development in preterm infants.
• Analysis of factors contributing to increased blood pressure, including nephrogenesis, arterial elasticity, and endothelial function.
• Exploration of the role of ADMA and the renin-angiotensin-aldosterone system.

Main Results:

• Incomplete nephrogenesis leads to fewer nephrons, reduced filtration, and increased sodium reabsorption.
• Elastin deficiency in the aorta contributes to arterial rigidity and elevated systolic blood pressure.
• Reduced nitric oxide bioavailability, exacerbated by elevated ADMA levels, promotes vasoconstriction.

Conclusions:

• Multiple developmental factors converge to increase hypertension risk in preterm individuals.
• Understanding these mechanisms is crucial for early detection and intervention strategies.
• Metabolomics offers a promising avenue for identifying novel biomarkers and therapeutic targets.