The vascular endothelium in normal pregnancy and pre-eclampsia

Hypertensive disorders of pregnancy affect up to 15% of pregnancies and the most severe form, pre-eclampsia, is the leading cause of maternal death in the UK today. Pre-eclampsia is a multisystem disorder affecting virtually every organ and system in the body, with hypertension and proteinuria, the traditional diagnostic features, representing two facets of a complex pathophysiological process. The common pathological feature of the disease, whether in the decidual vessels of the placental bed, renal microvasculature, liver, heart or cerebral circulation, is vascular endothelial damage and dysfunction. Before new ways of preventing or ameliorating hypertensive disorders of pregnancy can be found, we must first understand the pathophysiological mechanisms underlying the clinical problem. This review summarizes the evidence that endothelial dysfunction plays a key role in hypertensive disorders of pregnancy and will focus on the most severe form, pre-eclampsia.