Evaluation of the Blood Pressure Load in the Diagnosis of Hypertension in Pregnancy

Hermida, Ramón C.; Ayala, Diana E.

doi:10.1161/01.hyp.38.3.723

Cited by 18 publications

(10 citation statements)

References 27 publications

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“…27 The combination of tolerance intervals as time-varying reference threshold for BP with the hyperbaric index as a measure of BP excess has lead to define the so-called tolerance-hyperbaric test. 21,22 This test, and therefore the hyperbaric index as measure of BP excess, has already been shown to provide a much higher sensitivity and specificity in the diagnosis of hypertension 22 as well as in the early identification of hypertensive complications in pregnancy 21 compared with those of the 24-hour mean value 28 or the BP load, 6,10,29 parameters also calculated from the BP series obtained by ABPM. For the women investigated in this study, sensitivity of the tolerance-hyperbaric test was 94% for women sampled in the first trimester of gestation and increased up to 99% in the third trimester.…”

Section: Hermida Et Al Tolerance Limits For Bp In Pregnancy 749mentioning

confidence: 99%

Time-Qualified Reference Values for Ambulatory Blood Pressure Monitoring in Pregnancy

et al. 2001

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Abstract-To recognize the highly statistically significant circadian variability of blood pressure in pregnancy is to admit that the diagnosis of gestational hypertension or preeclampsia should be based not just on whether a casual blood pressure value is too high or too low, but rather on more pertinent questions: How long is blood pressure elevated above a given time-varying threshold? What is the excess blood pressure? When does most of the excess occur? Answers to these questions may be obtained by establishing (1) an adequate reference threshold for blood pressure and (2) a proper measurement of blood pressure elevation. Accordingly, we derived time-specified reference standards for blood pressure as a function of gestational age. We analyzed 1408 blood pressure series systematically sampled by ambulatory monitoring for 48 consecutive hours every 4 weeks from the first obstetric visit (usually within the first trimester of pregnancy) until delivery in 235 women with uncomplicated pregnancies. Data from each blood pressure series were synchronized according to the rest-activity cycle of each individual to avoid differences among women in actual times of daily activity. Data were then used to compute 90% circadian tolerance intervals for each trimester of pregnancy, in keeping with the trends in blood pressure along gestation previously documented. The method, derived on the basis of bootstrap techniques, does not need to assume normality or symmetry in the data, and therefore, it is highly appropriate to describe the circadian pattern of blood pressure variability. Results not only reflect expected changes in the tolerance limits as a function of gestational age, but also upper limits markedly below the thresholds currently used for diagnosing hypertension in pregnancy. The use of these time-qualified tolerance limits for the computation of a hyperbaric index as a measure of BP excess has already been show to provide high sensitivity and specificity in the early identification of gestational hypertension and preeclampsia. Key Words: blood pressure Ⅲ heart rate Ⅲ pregnancy Ⅲ circadian Ⅲ blood pressure monitoring, ambulatory T he construction of time-specified reference limits requires systematic sampling in clinical health, in particular for those variables that are characterized by circadian rhythms of large amplitude, as is the case for blood pressure (BP). To date, BP determined casually in the examiner's office has been commonly used to diagnose hypertension and evaluate treatment efficacy. 1 These conventional timeunspecified single measurements may be misleading because BP and heart rate (HR) vary according to a spectrum of rhythms with several frequencies (the circadian in particular) and because measurements may be influenced by a host of internal factors, such as autonomic nervous system tone, vasoactive hormones, and hematologic and renal variables, plus a variety of external factors, including ambient temperature/humidity, physical activity, emotional state, alcohol/ caffeine consumption, meal comp...

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Section: Hermida Et Al Tolerance Limits For Bp In Pregnancy 749mentioning

confidence: 99%

Time-Qualified Reference Values for Ambulatory Blood Pressure Monitoring in Pregnancy

et al. 2001

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“…6,11 Once the time-varying threshold, given, for instance, by the upper limit of a tolerance interval, 11 is available, the hyperbaric index (HBI), as a proper determinant of BP excess, 6,12 can be calculated as the total area of any given patient's BP above the threshold. The HBI has been shown to be a better determinant of BP excess than the BP load (percentage of BP values above a constant threshold 13 ) for the diagnosis of hypertension in pregnancy. This so-called tolerance-hyperbaric test has already been shown prospectively to provide high sensitivity and specificity for the early identification of subsequent hypertensive complications in pregnancy.…”

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confidence: 99%

Prognostic Value of Office and Ambulatory Blood Pressure Measurements in Pregnancy

Hermida

Ayala

2002

Hypertension

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Abstract-With the objective to assess the prognostic value of office values as compared with ambulatory monitoring in pregnancy, we analyzed 2430 blood pressure series systematically sampled from 403 untreated pregnant women for 48 consecutive hours every 4 weeks from the first visit to the hospital until delivery. Women were divided into 5 groups: "detected" gestational hypertension, women with office blood pressures Ͼ140/90 mm Hg after 20 weeks of gestation and hyperbaric index (area of blood pressure excess above the upper limit of a time-specified tolerance interval) consistently above the threshold for diagnosing hypertension in pregnancy; "undetected" gestational hypertension, office values Ͻ140/90 mm Hg but hyperbaric index above the threshold for diagnosis; normotension, both office values and hyperbaric index below the thresholds for diagnosis; white coat hypertension, women with recorded diagnosis of gestational hypertension but hyperbaric index consistently below the threshold for diagnosis; and preeclampsia, defined as gestational hypertension and proteinuria. Results indicate small and nonsignificant differences in 24-hour mean of ambulatory pressures between "detected" and "undetected" gestational hypertension at all stages of pregnancy, in contrast with highly significant differences between these two groups and normotensive pregnancies. Average office blood pressure values were similar for preeclampsia, "detected," and "undetected" gestational hypertension. The hyperbaric index was, however, significantly higher for women with preeclampsia after 20 weeks of gestation as compared with all other groups and higher for women with either "detected" or "undetected" gestational hypertension as compared with normotensive pregnant women. The incidence of preterm delivery and intrauterine growth retardation were similar for "detected" and "undetected" gestational hypertension but significantly lower for normotensive women. Key Words: blood pressure monitoring, ambulatory Ⅲ hypertension, pregnancy Ⅲ preeclampsia Ⅲ blood pressure determination T he diagnosis of gestational hypertension still relies on office blood pressure (BP) measurements and the use of arbitrary constant critical thresholds: 140/90 mm Hg for systolic (SBP)/diastolic BP (DBP) after 20 weeks of gestation in a previously normotensive woman. 1,2 These clinical BP values, however, have several shortcomings; they provide a measurement that represents only a fraction of the 24-hour BP profile, usually under circumstances that may have a pressor effect, and the technique is fraught with potential errors including instrument defects and examiner technique. 2,3 Therefore, office BP readings are neither diagnostic of nor a good predictor for the development of hypertension in pregnancy. 4,5 The use of ambulatory BP monitoring (ABPM) has been suggested as the logical approach to overcoming many of the problems associated with clinical BP measurement. 6,7 By the use of ABPM, differences between healthy and complicated pregnancies in the circadian patt...

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“…We have at 12 weeks a 72% sensitivity and 64% specificity, but this improves when measuring at 20 weeks again: 86% sensitivity and 69% specificity. This suggests that the current obstetric practice may benefit from changing the currently used 'gold standard of blood pressure measurement' by using different and gestation specific cut off values, a suggestion which has already be postulated by Hermida et al [21]. This may be useful to all clinics where technologies to screen for gestational hypertensive disease are not available and potentially to those women considered for initiating preventive medications such as low-dose aspirin [22,23] or calcium [24].…”

Section: Discussionmentioning

confidence: 99%

Optimization of Simple Sphygmomanometric Blood Pressure Measurement in Routine Prenatal Care

Vonck¹,

Oben²,

As³

et al. 2017

Health Care Current Reviews

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Background: Despite reported early subclinical hypertension of women at risk, blood pressures at threshold 140/90 mm Hg are used today to guide prenatal care. We aim to investigate the most appropriate gestation-specific threshold to measure early gestational blood pressures, allowing for a simple stratification between pregnant women at low/high risk for hypertension. Methods:Singleton pregnancies were selected at Clinic Oost-Limburg, Genk, Belgium. A standard protocol was used to measure systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP) in supine and standing position, by mode of an oscillometric sphygmomanometer around 12 and 20 weeks of gestation. After delivery, outcome was categorized in normotensive or hypertensive pregnancies. In a subgroup, routine blood pressures retrieved from prenatal records were compared to standardized blood pressures. ROC analysis was used to define early gestational blood pressure thresholds with best discriminative performance for hypertension. All analyses were done in SPSS software (α ≤ 0.05).Results: A total of 780 women were measured at 12 weeks, of which 433 pregnant women were re-evaluated around 20 weeks. At both occasions, blood pressures were significantly higher in hypertensive than in normotensive pregnancies (p<0.0001). Analysis showed for DBP in standing position at cut off 79 mmHg a sensitivity, specificity, positive predictive value and negative predictive value of 72%, 64%, 15,5% and 96% at 12 weeks and 86%, 69%, 20% and 98% at 20 weeks at cut off 77 mm Hg. At 20 weeks, Area under the Curve (AUC) for DBP was 83% in standing position and 80% in supine position. For routine versus standardized blood pressure measurement, AUC was 66% versus 72% at 12 weeks and 69% versus 82% at 20 weeks, respectively. Conclusion:Simple blood pressure measurements with gestation-specific thresholds can easily be used worldwide towards improved planning of prenatal care as compared to current protocols. women who remain normotensive. Today, subclinical higher blood pressures (<140/90 mm Hg) are not considered clinically relevant. In this study, we evaluated whether early gestational diagnosis of subclinical hypertension would be helpful to identify the proportion of women destined to develop GHD, as early identification of those high risk cases could help decreasing the maternal and neonatal consequences [12]. Optimization of Simple Sphygmomanometric Blood Pressure Measurement in Routine Prenatal Methods PatientsWomen with singleton pregnancies in first or second trimester, attending the obstetric ultrasound clinic (Ziekenhuis Oost-Limburg, Genk, Belgium) for their routine obstetrics scans, were invited to

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Evaluation of the Blood Pressure Load in the Diagnosis of Hypertension in Pregnancy

Cited by 18 publications

References 27 publications

Time-Qualified Reference Values for Ambulatory Blood Pressure Monitoring in Pregnancy

Time-Qualified Reference Values for Ambulatory Blood Pressure Monitoring in Pregnancy

Prognostic Value of Office and Ambulatory Blood Pressure Measurements in Pregnancy

Optimization of Simple Sphygmomanometric Blood Pressure Measurement in Routine Prenatal Care

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