Appraising the Preclinical Evidence of the Role of the Renin-Angiotensin-Aldosterone System in Antenatal Programming of Maternal and Offspring Cardiovascular Health Across the Life Course: Moving the Field Forward: A Scientific Statement from the American Heart Association

Barbara T. Alexander, Andrew M. South, Phyllis August, Mariane Bertagnolli, Erin P. Ferranti, Justin L. Grobe, Emily J. Jones, Analia S. Loria, Basmah Safdar, Maria Luisa Soledad Sequeira-Lopez

Research output: Contribution to journalReview articlepeer-review

10 Scopus citations

Abstract

There is increasing interest in the long-term cardiovascular health of women with complicated pregnancies and their affected offspring. Emerging antenatal risk factors such as preeclampsia appear to increase the risk of hypertension and cardiovascular disease across the life course in both the offspring and women after pregnancy. However, the antenatal programming mechanisms responsible are complex and incompletely understood, with roots in alterations in the development, structure, and function of the kidney, heart, vasculature, and brain. The renin-angiotensin-aldosterone system is a major regulator of maternal-fetal health through the placental interface, as well as kidney and cardiovascular tissue development and function. Renin-angiotensin-aldosterone system dysregulation plays a critical role in the development of pregnancy complications such as preeclampsia and programming of long-term adverse cardiovascular health in both the mother and the offspring. An improved understanding of antenatal renin-angiotensin-aldosterone system programming is crucial to identify at-risk individuals and to facilitate development of novel therapies to prevent and treat disease across the life course. Given the inherent complexities of the renin-angiotensin-aldosterone system, it is imperative that preclinical and translational research studies adhere to best practices to accurately and rigorously measure components of the renin-angiotensin-aldosterone system. This comprehensive synthesis of preclinical and translational scientific evidence of the mechanistic role of the renin-angiotensin-aldosterone system in antenatal programming of hypertension and cardiovascular disease will help (1) to ensure that future research uses best research practices, (2) to identify pressing needs, and (3) to guide future investigations to maximize potential outcomes. This will facilitate more rapid and efficient translation to clinical care and improve health outcomes.

Original languageEnglish
Pages (from-to)E75-E89
JournalHypertension
Volume80
Issue number5
DOIs
StatePublished - May 1 2023

Bibliographical note

Publisher Copyright:
© 2023 American Heart Association, Inc.

Keywords

  • AHA Scientific Statements
  • aldosterone
  • angiotensin-converting enzyme 2
  • hypertension
  • pre-eclampsia
  • pregnancy
  • renin-angiotensin system

ASJC Scopus subject areas

  • Internal Medicine

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