{"id":"659360896250","type":"article","url":"https://hartvaat.nl/2026/12/31/behandeling-milde-chronische-hypertensie-tot-onder-140-90-mmhg-vermindert-advers/","title":"Behandeling milde chronische hypertensie tot onder 140/90 mmHg vermindert adverse uitkomsten bij zwangerschap — overzicht","title_en":"Hypertensive disorders of pregnancy: epidemiology, pathophysiology, therapeutic strategies, and maternal-offspring outcomes.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension in pregnancy","doi":"10.1080/10641955.2026.2742300","source_url":"https://doi.org/10.1080/10641955.2026.2742300","authors":["Chengcheng Mu","Shouzhu Xu","Bing Xu","Dongdong Wu","Xinrui Chang","Donglin Yang","Ting Ye","Jing Zhao","Xiaohang Yang"],"significance":5,"published":"2026-10-20","source_date":"2026-12-31","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This narrative review synthesizes current evidence on hypertensive disorders of pregnancy (HDP), covering epidemiology, pathophysiology, and clinical management. Management of mild chronic hypertension to below 140/90 mmHg reduces adverse maternal and fetal outcomes without compromising fetal growth, while the sFlt-1/PlGF ratio remains a validated tool for short-term preeclampsia risk stratification. Given the established link between HDP and long-term cardiovascular and metabolic disease, women with a history of HDP require structured lifelong cardiovascular risk assessment and prevention strategies.","created":"2026-10-14T00:46:44Z","updated":"2026-10-14T00:46:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Deze narratieve review belicht de epidemiologie, pathofysiologie en klinische aanpak van hypertensieve zwangerschapsaandoeningen, waaronder pre-eclampsie en chronische hypertensie. Bewijs ondersteunt het behandelen van milde chronische hypertensie tot onder 140/90 mmHg om adverse uitkomsten te verminderen zonder de foetale groei te beïnvloeden, terwijl de sFlt-1/PlGF-ratio een gevalideerd instrument blijft voor kortetermijnrisicobeoordeling. Vrouwen met een voorgeschiedenis van HZA hebben een verhoogd langetermijnrisico op cardiovasculaire en metabole aandoeningen, wat structurele follow-up in de eerstelijns en tweedelijnszorg rechtvaardigt.","abstract_original":"Hypertensive disorders of pregnancy (HDP) encompass chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension, affecting about 5% to 10% of pregnancies worldwide and remaining a major cause of maternal and perinatal morbidity and mortality. Their burden is increasing with rising obesity, advanced maternal age, evolving diagnostic criteria, and marked socioeconomic and racial-ethnic disparities. This review summarises current evidence on the epidemiology, pathophysiology, biomarkers, clinical management, and long-term outcomes of HDP, highlighting recent advances and unresolved questions. Mechanistically, HDP is characterised by systemic endothelial dysfunction and angiogenic imbalance, particularly involving soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng), together with immune maladaptation, oxidative stress, and genetic and environmental contributors such as endocrine-disrupting chemicals (EDCs) and sleep-disordered breathing (SDB). The sFlt-1/PlGF ratio is among the most validated tools for short-term risk assessment in suspected preeclampsia, while retinal microvascular imaging may provide a non-invasive marker of systemic microvascular dysfunction. Clinically, trial evidence supports treating mild chronic hypertension to below 140/90 mmHg to reduce adverse outcomes without compromising foetal growth. Long-term maternal cardiovascular and metabolic risks vary according to HDP phenotype, severity, gestational age at onset, and associated preterm delivery or foetal growth restriction, whereas offspring neurodevelopmental associations are largely observational and may be influenced by prematurity and shared familial or socioeconomic factors. Experimental strategies supported primarily by preclinical or early translational evidence include PPARγ agonists, placenta-targeted nanomedicine, and transcutaneous auricular vagus nerve stimulation. Machine learning combined with longitudinal multi-omics data may support precision risk stratification and individualised management."}