Hypertension in Pregnancy

Murnaghan, George A.

doi:10.1097/00006254-197707000-00006

Cited by 5 publications

(1 citation statement)

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“…1,8 -12 Recent studies have tried to overcome the poor results from isolated BP measurements during the second trimester in detecting preeclampsia by relying on ABPM. By the use of this approach, several authors have found a reduced drop in BP by night in preeclamptic patients, [13][14][15] whereas others even report an inversion of the circadian pattern of change in BP associated with preeclampsia. 16 -18 Most of these studies have usually being carried out during the second or third trimester of pregnancy.…”

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confidence: 99%

Blood Pressure Excess for the Early Identification of Gestational Hypertension and Preeclampsia

et al. 1998

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Abstract-We have examined prospectively whether the combined approach of establishing tolerance intervals for the circadian variability of blood pressure (BP) as a function of gestational age, and then determining the so-called hyperbaric index (area of BP excess above the upper limit of the tolerance interval) by comparison of any patient's BP profile (obtained by ambulatory monitoring) with those intervals provides a high sensitivity test for the early detection of pregnant women who subsequently will develop gestational hypertension or preeclampsia. We analyzed 657 BP series from 92 women with uncomplicated pregnancies and 378 series from 60 women who developed gestational hypertension or preeclampsia. BP was sampled for about 48 hours once every 4 weeks after the first obstetric consultation. Circadian 90% tolerance limits were determined as a function of trimester of gestation from 497 series previously sampled from a reference group of 189 normotensive pregnant women. The hyperbaric index was then determined for each individual BP series in the validation sample. Sensitivity of this test for diagnosing gestational hypertension was 93% for women sampled during the first trimester of gestation and increased up to 99% in the third trimester. The positive and negative predictive values were above 96% in all trimesters. Despite the limitations of ambulatory monitoring, the approach presented here, now validated prospectively, represents a reproducible, noninvasive, and high sensitivity test for the very early identification of subsequent gestational hypertension and preeclampsia, on the average, 23 weeks before the clinical confirmation of the disease. Key Words: Ⅲ blood pressure Ⅲ diagnostic test Ⅲ tolerance intervals Ⅲ hyperbaric index Ⅲ human pregnancy Ⅲ normotension Ⅲ hypertension, gestational Ⅲ preeclampsia I n order to predict the occurrence of gestational hypertension or even preeclampsia, several (clinical, biochemical, and biophysical) tests have been designed with various degrees of specificity and sensitivity.1 Gant et al 2 proposed the roll-over or supine pressor test for predicting the development of acute hypertension in pregnancy. The results of this test are highly variable among different investigators, and there is poor reproducibility in the same patient.1 Therefore, although the roll-over test has gained some popularity because of its simplicity, it is of little use clinically as a predictive test. Intravenous infusion of angiotensin II was reported to cause a smaller rise in BP in pregnant women than in nonpregnant women.3 These results were complemented by the finding that the relative refractoriness to the pressor effects of angiotensin II is lost to a marked extent in women who subsequently developed preeclampsia. [4][5][6] As for the roll-over test, sensitivity and specificity of the angiotensin II test varied greatly among different studies. Moreover, this test is too complicated and time consuming to be used as a clinical screening procedure. 1Because an elevated BP is the hallmark fo...

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confidence: 99%