Vascular reactivity to angiotensin II infusion during gestation

We serially tested 26 healthy, young, nulliparous patients, while they were maintained in the left lateral recumbent position, during a four-week interval (29 to 32 weeks), with progressive increments of angiotensin-II (A-II) 2.0 to 15.0 ng. per kilogram per minute). Blood pressure was recorded with an ultrasound device. All patients were followed through delivery. Three patients (12 per cent) developed pregnancy-induced hypertension (PIH); only one of these demonstrated enhanced vasoreactivity prior to PIH. Conversely, 13 patients who did not develop PIH demonstrated enhanced vasoreactivity at least once during the testing interval. Comparison of results obtained from one week to the next was evaluated in 57 test pairs; discordant data, i.e. reaction to less than 8 ng. per kilogram per minute one week and nonreaction the next, was observed in 17 pairs (30 per cent). We conclude that assessment of the risk of PIH, with the use of the diastolic pressor response to infused A-II, is unreliable.