JNEPHROL 2008; 21: 663-672 REVIEW 663 ABSTRACT The pathophysiological mechanisms underlying preeclampsia, a serious complication of pregnancy, are largely unknown. Since, on the other hand, the various risk factors are known, primary and secondary preven- tion with pre- and inter-pregnancy counseling should be undertaken, and a follow-up should be conducted to e- valuate any long-term organic complications. There is evidence in the literature that women with preeclampsia are particularly predisposed to developing cardiovascu- lar diseases, especially ischemia, and it is justifiably be- lieved that preeclampsia and atherosclerosis share the same risk factors. However, further understanding is re- quired concerning the risk of long-term dysfunctions in other organs also involved in the course of preeclamp- sia: the kidneys, liver and brain. Preeclampsia is, more- over, a complex multispecialist entity, and the internist and/or the intensivist can be important allies along with the obstetrician in the management of this condition. Key words: Atherosclerosis, Cardiovascular risk, Counsel- ing, Hypertension, Preeclampsia INTRODUCTION Preeclampsia is a systemic disorder which complicates 5% to 7% of all pregnancies (1). The diagnostic criteria for preeclampsia developed by the National Blood Pressure Education Program Working Group are traditionally used in clinical practice and frequently employed in research proto- cols (2). They are as follows: (i) systolic blood pressure ≥140 mm Hg or higher or diastolic blood pressure ≥90 mm Hg occurring after 20 weeks of gestation in a woman whose blood pressure has previously been normal; and (ii) protein- uria, defined as protein excretion of 0.3 g or more in a 24- hour urine specimen. According to the WHO criteria, every year about 50,000 women suffer from the complications of this disease, including abruptio placentae, intra-abdominal hemorrhage, brain hemorrhage, heart and multiorgan failure (3). Preeclampsia is, moreover, one of the most important causes of fetal complications: fetal mortality in women with preeclampsia is about 2.2%, against 0.9% in those with a normal pregnancy, and severe preeclampsia is significantly correlated with delayed intrauterine growth (<5th percentile) (4). Edema, which was included in the “classic” criteria for diagnosis of preeclampsia, is not always specific and/or pathognomonic. For a reliable diagnosis, the arterial pressure must be higher than 140/90 mm Hg in women without a his- tory of hypertension, and this finding must be made after the 20th week of pregnancy (5) (differential diagnosis from gesta- tional hypertension); increased arterial pressure must be found at least twice in occasional measurements using an adequate arm sleeve (6). Preeclampsia can also occur with isolated systolic or diastolic hypertension. Systolic arterial pressure higher than 160 mm Hg or diastolic pressure higher than 110 mm Hg define severe preeclamptic syndrome (20%- Michele Buemi 1 , Davide Bolignano 1 , Antonio Barilla 1 , Lorena Nostro 1 , Eleonora Crasci 1 , Susanna Campo 1 , Giuseppe Coppolino 1 , Rosario D’Anna 2 1 Chair of Nephrology, University of Messina, Messina - Italy 2 Department of Gynecology, University of Messina, Messina - Italy Preeclampsia and cardiovascular risk: general characteristics, counseling and follow-up www.sin-italy.org/jnonline – www.jnephrol.com