Introduction
pre-eclampsia/eclampsia, Hypertensive disorders, gastrointestinal and liver metabolism [Amino acid, hypertension
HYPERTENSION, EARLY PREGNANCY, GESTATIONAL HYPERTENSION, HYPERTENSIVE DISORDER, PATHOLOGY
Hypertensive disorders of pregnancy (HDPs), comprising chronic hypertension, gestational hypertension and pre-eclampsia/eclampsia, affect around 1 in 10 pregnancies [Abnormal endothelial function and impaired nitric oxide (NO) pathways are strongly implicated in the pathology of HDPs [L-arginine is subject to extensive elimination by gut bacteria and systemic arginases and in the case of pregnancy by placental arginases. Oral L-citrulline is less subject to degradation as it bypasses gastrointestinal and liver metabolism [Amino acid supplements, which are readily available and relatively low-cost, present an appealing intervention for HDP, where treatment options are limited. To our knowledge at present, there is no information regarding either the efficacy or acceptability of L-citrulline supplementation to modulate cardiovascular function in women with chronic hypertension in early pregnancy.The aims of this early phase feasibility randomised trial were therefore (i) to assess the acceptability of L-citrulline supplementation during pregnancy in women with chronic hypertension, (ii) to determine the effect of L-citrulline supplementation on maternal BP and (iii) to determine whether L-citrulline supplementation is associated with a change in uterine blood flow and other markers associated with adverse pregnancy outcomes.