Preeclampsia — A State of Sympathetic Overactivity

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Abstract
Schobel et al. (Nov. 14 issue)1 present convincing evidence, based on intraneural recordings of sympathetic-nerve activity in muscle-nerve fascicles, that preeclampsia is accompanied by sympathetic overactivity. We would like to offer an explanation for their findings that the authors did not consider. Recent evidence indicates that preeclampsia is an insulin-resistant state. Increased insulin levels and insulin resistance over and above those that already accompany pregnancy have been shown to predict pregnancy-associated hypertension.2 Notably, in pregnancy, as in the nonpregnant state, a relation between the insulin level and blood pressure persists despite the physiologic decrease in blood pressure.3 Hyperinsulinemia, in turn, has been shown to increase the sympathetic-nerve activity of skeletal muscle,4 the supposed site of the defect in glucose metabolism found in almost half of patients with essential hypertension.