Diagnosis and Monitoring of White Coat Hypertension in Pregnancy: an ISSHP Consensus Delphi Procedure

Johnson, Sonia; Gordijn, Sanne J.; Damhuis, Stefanie Elisabeth; Ganzevoort, Wessel; Brown, Mark; Dadelszen, Peter von; Khalil, Asma

doi:10.1161/hypertensionaha.121.18356

Cited by 9 publications

(12 citation statements)

References 29 publications

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“…BP 135–139/85–89 mmHg), suggesting that the latter is an appropriate target for action when BP is measured in the community. These data support the findings of the International Society for the Study of Hypertension in Pregnancy (ISSHP) Delphi consensus regarding home BP monitoring 18 …”

Section: Discussionsupporting

confidence: 85%

“…The following conclusions and recommendations for digital BP device and related app design for the assessment of BP in pregnancy include: ‘Traffic light’ thresholds for women measuring their BP at home should be 5 mmHg lower than when women are being assessed in formal healthcare settings 18 . This means that the ‘amber’ light would trigger at a BP of 135/85 mmHg, and the ‘red’ light at 155/105 mmHg, triggering appropriate care pathways.…”

Section: Discussionmentioning

confidence: 99%

“…Outputs were sBP and/or dBP, as currently recommended in practice, 20 sBP only, dBP only and MAP. BP level was defined as: normotension‐1 (N1), as sBP <135 mmHg and dBP <85 mmHg; normotension‐2 (N2), as sBP 135–139 mmHg or dBP 85–89 mmHg; (iii) non‐severe hypertension‐A, as sBP 140–149 mmHg or dBP 90–99 mmHg; (iv) non‐severe hypertension‐B, as sBP 150–154 mmHg or dBP 100–104 mmHg; (iv) non‐severe hypertension‐C, as sBP 155–159 mmHg or dBP 105–109 mmHg; (iv) severe hypertension, as sBP ≥160 mmHg or dBP ≥110 mmHg 18 …”

Section: Methodsmentioning

confidence: 99%

“…These data support the findings of the International Society for the Study of Hypertension in Pregnancy (ISSHP) Delphi consensus regarding home BP monitoring. 18 Importantly, no BP category, even normotension-2, had even a fair −LR, suggesting that a normal BP is not useful in identifying women at low risk of developing adverse outcomes in the future. In this dataset previously, we determined that the same was true for the 130/80 mmHg ('Stage 1 hypertension') and 120 mmHg systolic ('Elevated BP') recommended outside pregnancy by 2017 American guidelines.…”

Section: Interpretation In Light Of Other Evidencementioning

confidence: 99%

“…Using population-level, 3AS1-2®-derived data from the three Community-Level Interventions for Pre-eclampsia (CLIP) trials, [12][13][14][15] we have shown that diagnostic BP thresholds in pregnancy should not be lowered to those suggested by the American College of Cardiology and the American Heart Association (ACC-AHA). 16,17 However, a recent Delphi consensus has supported using BP values that are 5 mmHg lower when measured in a community (such as at home), compared with office BP values; 18 this means that 140/90 mmHg in the office would be equivalent to 135/85 mmHg in the community, and 160/110 mmHg equivalent to 155/105 mmHg.…”

Section: Introductionmentioning

confidence: 99%

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Choosing blood pressure thresholds to inform pregnancy care in the community: An analysis of cluster trials

Dadelszen

Bone

Sandhu

et al. 2023

BJOG

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Objective: To inform digital health design by evaluating diagnostic test properties of antenatal blood pressure (BP) outputs and levels to identify women at risk of adverse outcomes. Design: Planned secondary analysis of cluster randomised trials. Setting: India, Pakistan, Mozambique. Population: Women with in-community BP measurements and known pregnancy outcomes. Methods: Blood pressure was defined by its outputs (systolic and/or diastolic, systolic only, diastolic only or mean arterial pressure [calculated]) and level: normotension-1 (<135/85 mmHg), normotension-2 (135-139/85-89 mmHg), non-severe hypertension (140-149/90-99 mmHg; 150-154/100-104 mmHg; 155-159/105-109 mmHg) and severe hypertension (≥160/110 mmHg). Dose-response (adjusted risk ratio [aRR]) and diagnostic test properties (negative [−LR] and positive [+LR] likelihood ratios) were estimated. Main Outcome Measures: Maternal/perinatal composites of mortality/morbidity. Results: Among 21 069 pregnancies, different BP outputs had similar aRR, −LR, and +LR for adverse outcomes. No BP level (even normotension-1) was associated with low risk (all −LR ≥0.20). Across outcomes, risks rose progressively with higher BP levels above K E Y W O R D S blood pressure thresholds, community, digital health, pregnancy

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Interpretation In Light Of Other Evidencementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Choosing blood pressure thresholds to inform pregnancy care in the community: An analysis of cluster trials

Dadelszen

Bone

Sandhu

et al. 2023

BJOG

Self Cite

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Hypertension phenotypes and adverse pregnancy outcome-related office and ambulatory blood pressure thresholds during pregnancy: a retrospective cohort study

Fang,

Zuo,

Duan

et al. 2024

Hypertens Res

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Assessing Severity and Need for Delivery in Early Onset Preeclampsia Before 32 Weeks of Gestation: a Delphi Consensus Procedure

Brodowski,

Knoth,

Zehner

et al. 2024

Geburtshilfe Frauenheilkd

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Preeclampsia is a potentially life-threatening hypertensive pregnancy disorder that carries an acute risk of an unfavorable outcome of the pregnancy but also has consequences for the long-term health of the mother. Women who develop the early form of pre-eclampsia before the 32nd week of pregnancy have the highest risk and are also the most difficult to treat. The severity of pre-eclampsia is not characterized uniformly in Germany, so that the indication for delivery is rather individualized. The aim of this study was to reach a consensus on parameters that could serve as criteria for describing the severity of pre-eclampsia based on the urgency of delivery. To this end, a Delphi procedure was used to present a scenario in which a woman was admitted for preeclampsia before 32 gestational weeks and after completion of antenatal steroid therapy.Clinicians specialized in maternal-fetal medicine from German-speaking countries completed five rounds of a modified Delphi questionnaire. Presented parameters were selected by the section “Hypertensive Pregnancy Diseases and Fetal Growth Restriction” of the German Society of Gynecology and Obstetrics after reviewing the literature. These included objectifiable laboratory or clinical parameters as well as subjective symptoms of the patient. In addition, nine fetal parameters were taken into account. The clinicians were asked to rate presented parameters as an indication for delivery on a Likert scale from 0 to 4 (no indication to absolute indication without delay). For each item, the predefined cut-off for group consensus was ≥ 70% agreement.A total of 126 experts were approached. Sixty-nine experts (54.8%) took part in the first round; of those 50 completed the entire Delphi procedure. A consensus was reached on 14 parameters to be considered rapid preparation for delivery without delay (4 points on the Likert scale). These were among others hepatic hematoma or liver capsule rupture, acute liver failure with fulminant coagulation disorder or disseminated intravascular coagulation, eclampsia, pathologic findings in imaging (e.g. cMRI) or electrocardiogram arranged for new onset of headache or retrosternal pain, respectively. Twenty-six parameters were rated as factors that should be considered in the decision without being absolute (1 to 3 points), and 13 parameters should have no influence on the decision to deliver (0 points). No consensus on severe hypertension as an indication for delivery could be reached for blood pressure values below 220/140 mmHg.A consensus was reached on whether to deliver in preeclampsia typic clinical findings and symptoms. The results can serve as guidance for current clinical practice and for the definition of clinical endpoints in intervention studies. Nevertheless, the isolated criteria are a theoretical construction since the combined deterioration or summation of several factors rather than a single factor most likely influences the decision to deliver and reflect the severity of preeclampsia. Moreover, the degree of hypertension as an indication for delivery remains controversial, unless the patient suffers additionally from complaints. Future research should be enforced to incorporate long-term risks for the mother into a decision aid.

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Diagnosis and Monitoring of White Coat Hypertension in Pregnancy: an ISSHP Consensus Delphi Procedure

Cited by 9 publications

References 29 publications

Choosing blood pressure thresholds to inform pregnancy care in the community: An analysis of cluster trials

Choosing blood pressure thresholds to inform pregnancy care in the community: An analysis of cluster trials

Hypertension phenotypes and adverse pregnancy outcome-related office and ambulatory blood pressure thresholds during pregnancy: a retrospective cohort study

Assessing Severity and Need for Delivery in Early Onset Preeclampsia Before 32 Weeks of Gestation: a Delphi Consensus Procedure

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