Beat-to-Beat Blood Pressure Variability in the First Trimester Is Associated With the Development of Preeclampsia in a Prospective Cohort

Abstract

Women with preeclampsia, a hypertensive disorder of pregnancy, exhibit greater beat-to-beat blood pressure variability (BPV) in the third trimester after clinical onset of the disorder. However, it remains unknown whether elevated BPV precedes the development of preeclampsia. A prospective study cohort of 139 women (age 30.2±4.0 years) were enrolled in early pregnancy (<14 weeks gestation). BPV was quantified by time domain analyses of 10-minute continuous beat-to-beat blood pressure recordings via finger photoplethysmography in the first, second, and third trimesters. Aortic stiffness (carotid-femoral pulse wave velocity) and spontaneous cardiovagal baroreflex sensitivity were also measured each trimester. Eighteen women (13%) developed preeclampsia. Systolic BPV was higher in all trimesters among women who developed versus did not develop preeclampsia (first: 4.8±1.3 versus 3.7±1.2, P =0.001; second: 5.1±1.8 versus 3.8±1.1, P =0.02; third: 5.2±0.8 versus 4.0±1.1 mm Hg, P =0.002). Elevated first trimester systolic BPV was associated with preeclampsia (odds ratio, 1.94 [95% CI, 1.27–2.99]), even after adjusting for risk factors (age, body mass index, systolic blood pressure, history of preeclampsia, and diabetes mellitus) and was a significant predictor of preeclampsia (area under the receiver operator characteristic curve=0.75±0.07; P =0.002). Carotid-femoral pulse wave velocity was elevated in the first trimester among women who developed preeclampsia (5.9±0.8 versus 5.2±0.8 m/s; P =0.002) and was associated with BPV after adjustment for mean blood pressure ( r =0.26; P =0.005). First trimester baroreflex sensitivity did not differ between groups ( P =0.23) and was not related to BPV ( P =0.36). Elevated systolic BPV is independently associated with the development of preeclampsia as early as the first trimester, possibly mediated in part by higher aortic stiffness.

Arterial stiffness measurements in pregnancy as a predictive tool for hypertensive disorders of pregnancy and preeclampsia: Protocol for a systematic review and meta-analysis

“…Moreover, AS is significantly higher in women with HDPs compared to normotensive pregnancies and further increases with disease severity [52] . In recent studies, we and others have demonstrated that AS measurements can detect altered hemodynamic responses in the first trimester of pregnancy in women who subsequently develop HDPs [53] , [54] , [55] , [56] , [57] , [58] . PWA parameters, CO, and FMD are also outcomes of interest in our study as they provide complementary information regarding overall vascular function and have been reported to be associated with HDPs.…”

Carotid Baroreceptor Magnetic Activation and Beat‐to‐Beat Blood Pressure Variability, Implications to Treat Abrupt Blood Pressure Elevation in Labile Hypertension

“…This relationship was not previously described and should be used as a diagnostic tool for selecting a high cardiovascular risk population with enhanced stress blood pressure reactivity [Munakata, 2018] by relatively simple arterial blood pressure standard deviation evaluation method. The coexistence of the enhanced short‐term BPV and blood pressure surges in preeclampsia [Nuckols et al, 2020] and pheochromocytoma [Bisogni et al, 2019] supports the BPV for predicting abrupt blood pressure elevations in susceptible individuals [Dawson et al, 2000; Tang et al, 2020]. On the other hand, the pharmacological and nonpharmacological approaches aimed to decrease enhanced beat‐to‐beat BPV may be employed to prevent abrupt blood pressure elevation and its malicious cardiovascular consequences.…”

Assessments of Perfusion, Blood Flow, and Vascular Structure in Ambulatory Subjects: Guidance for Translational Research Scientists

“…It is noted that the expected standard-of-practice is that reported PWV measurements are actually the average of two consecutive measurements or the median of three consecutive measurements if the difference between the first two exceeds 0.5 m/s [63]. [340,350,318,341,319,352,321,338,342,345,354,343,160,355,346,323,357,348,358,359,333,360,169,329,361,330,339,362,335,336,363,364] Peripheral arterial vasculature 16 [365, 349, 344, 351, 347, 337, 353, 322, 356, 324-327, 334, 328, 331] Carotid artery 2 [320,125] Aspect of vasculature assessed Arterial stiffness 49 [349, 340, 332, 350, 318, 344, 341, 351, 347, 319, 320, 352, 321, 337, 338, 353, 342, 322, 345, 354, 343, 160, 355, 346, 356, 125, 323, 324, 357, 348, 358, 325-327, 359, 333, 334, 360, 328, 169, 329, 361, 330, 339, 362, 335, 336, 363, 331, 364] Blood pressure 1 [349] Technique SphygmoCor device 12 [340,341,320,352,…”