HypertensionAHA SCIENTIFIC STATEMENTAppraising the Preclinical Evidence of the Roleof the Renin-Angiotensin-Aldosterone Systemin Antenatal Programming of Maternal andOffspring Cardiovascular Health Across the LifeCourse:Moving the Field Forward:A ScientificStatement From the American Heart AssociationBarbara T.Alexander,PhD,FAHA,Chair;Andrew M.South,MD,Vice Chair;Phyllis August,MD;Mariane Bertagnolli,PhD:Erin P.Ferranti,PhD;Justin L Grobe,PhD;Emily J.Jones,PhD,FAHA;Analia S.Loria,PhD;Basmah Safdar,MD;Maria Luisa Soledad Sequeira-Lopez,MD;on behalf of the American Heart Association Council on the Kidney in CardiovascularDisease;Council on Cardiovascular and Stroke Nursing;Council on Cardiovascular Radiology and Intervention:Council on Hyper-tension:and Council on Lifestyle and Cardiometabolic HealthABSTRACT:There is increasing interest in the long-term cardiovascular health of women with complicated pregnancies andtheir affected offspring.Emerging antenatal risk factors such as preeclampsia appear to increase the risk of hypertensionand cardiovascular disease across the life course in both the offspring and women after pregnancy.However,the antenatalprogramming mechanisms responsible are complex and incompletely understood,with roots in alterations in the development,structure,and function of the kidney,heart,vasculature,and brain.The renin-angiotensin-aldosterone system is a majorregulator of maternal-fetal health through the placental interface,as well as kidney and cardiovascular tissue developmentfromand function.Renin-angiotensin-aldosterone system dysregulation plays a critical role in the development of pregnancyhttp:/complications such as preeclampsia and programming of long-term adverse cardiovascular health in both the mother andthe offspring.An improved understanding of antenatal renin-angiotensin-aldosterone system programming is crucial toidentify at-risk individuals and to facilitate development of novel therapies to prevent and treat disease across the lifecourse.Given the inherent complexities of the renin-angiotensin-aldosterone system,it is imperative that preclinical andtranslational research studies adhere to best practices to accurately and rigorously measure components of the renin-angiotensin-aldosterone system.This comprehensive synthesis of preclinical and translational scientific evidence of themechanistic role of the renin-angiotensin-aldosterone system in antenatal programming of hypertension and cardiovasculardisease will help (1)to ensure that future research uses best research practices,(2)to identify pressing needs,and(3)toguide future investigations to maximize potential outcomes.This will facilitate more rapid and efficient translation to clinicalMarchcare and improve health outcomes.Key Words:AHA Scientific Statements aldosterone angiotensin-converting enzyme 2 hypertension pre-eclampsia pregnancyrenin-angiotensin systemhe antenatal period,spanning conception to birth,stated,antenatal programming happens when exp
