Seeking to reduce future heart disease risk after pre-eclampsia

Pre-eclampsia can lead to an increased risk of heart conditions and stroke later in life. Researchers at Manchester are looking at ways to reduce this risk in women who have had pre-eclampsia.

Pre-eclampsia is a serious condition that affects about 1 in 20 pregnant women. The main sign is hypertension (high blood pressure). Women with pre-eclampsia are more likely to develop heart disease and/or strokes in the future.

Our research aims to identify at risk women after pregnancy who could be targeted for treatment at an early stage and find an acceptable treatment to reduce their risk.

What we are doing

Enalapril is a drug that is well-established in clinical practice. It is already used by the NHS to treat high blood pressure.

Dr Laura Ormesher

Laura is an Honorary Research Fellow at The University of Manchester.

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@l_ormesher

In our pilot study, we found that in women with pre-term pre-eclampsia, six months of treatment with enalapril improved heart function compared with a placebo and standard NHS care.

We are now planning a larger, national clinical trial with the aim of improving the long-term health of women affected by this pregnancy complication.

Successful pilot study

Funded by the Medical Research Council (MRC), our pilot PICK-UP study (Postnatal enalapril to Improve Cardiovascular fUnction following preterm Pre-eclampsia) was carried out in the Manchester Antenatal Vascular Service (MAViS) Clinic within Manchester University NHS Foundation Trust (MFT). Enalapril was given to women after they had given birth, as the drug is not safe to take during pregnancy, but is safe for breast-feeding mothers.

Of the 44 women who had placebo or usual care, only two had a normal heart scan six months after birth, confirming that preterm pre-eclampsia is associated with persistent heart and blood pressure issues.

Demonstrating improved heart function

Echocardiography (ultrasound), measures of heart function and structure, found that postnatal enalapril treatment improved heart stiffness and thickness compared with a placebo and standard NHS care. These improvements have the potential to reduce long-term risk in these women.

Our study also confirmed acceptability and feasibility of the study protocol. The majority of women found the treatment easy to take and all women involved said they would be interested in taking the drug again after future pregnancies if it was found to be effective.

Future aims

Our PICK-UP study was the first step towards a treatment which could improve the long-term health of women affected by pre-eclampsia.

We are now seeking funding to carry out a larger, national trial, which we hope will confirm the benefits and move closer to making this treatment available to at-risk women.