New therapeutic approaches to treating hypertension in pregnancy

► Drug discovery in the field of preeclampsia is particularly sensitive.
► The pathophysiology of preeclampsia remains unknown.
► The discovery of possible common effector pathways is crucial
► Adenosine–l-arginine–nitric oxide pathway may be a preferential target
► l-Carnitine may have a relevant role in preeclampsia prevention.Pregnancy-related hypertensive disorders constitute a leading cause of morbidity and mortality. On occasion the precise classification of such hypertensive disorders can be difficult and, as treatments that target specific etiologies are being developed, there are needs to improve the specificity of the diagnosis. This is particularly important in preeclampsia, a hypertensive disorder always associated with a serious risk of maternal–fetal complications during and after pregnancy. The specific human nature of preeclampsia, the fact that conventional antihypertensive medications fail to reduce the risk of eclampsia and the lack of large, randomized multicenter trials to illustrate the safety of antihypertensives in pregnancy are all factors that make drug discovery in this field a particularly sensitive issue. Continued interest in preeclampsia has enabled significant progress during the past few years. As a consequence, potential new targets have been proposed in an attempt to avoid the only known ‘cure’ for this disease – premature delivery.