Night Diastolic Values of Ambulatory Blood Pressure Are the More Predictive of the Outcomes in Pregnancy Complicated With Hypertension

Abstract

Objective: The prognostic value of 24-hour ambulatory monitoring(ABPM) in pregnancy complicated with hypertension remains uncertain Design and method: Observational, 234 pregnant observed in appointment between 2007- July 2019 submitted to ABPM. Mean age 32.1 ± 5.5 years, follow-up 263.9 ± 16.5 days, was defined from gestation to delivery. Event defined: maternal death(MD), fetal or neo natal death(FD), pre-eclampsia (PE) or eclampsia(E), gestational diabetes(DG), prematurity or delayed fetal growth (PF), dystocic delivery(DD).It was observed 118 events((62 PE),32(DG),14 (PF),8(DD),2(FD)) Results: Comparing pregnancies with events versus without, those with event were significantly older, more prevalence of risk factors for BP in PG, shorter follow up / days, higher 24 h Systolic BP(SBP), 24 h Diastolic BP (DBP),day SBP and DBP, night SBP and DBP, lower Systolic and Diastolic Dipping (table 1). In Cox's multivariate analysis for events and adjusted for: age, BMI, number of risk factors for HP in PG - [pre-existing HP, previous gestational HP, previous pre-eclampsia,restriction of previous intrauterine growth, previous membrane detachment, previous fetal death, previous gestational diabetes, smoking history, obesity, family history of preeclampsia, family history of cardiovascular disease, artificial insemination]classified has:(0,1,2,3,> = 4), office SBP, office DBP, gestation n°, give birth n°, were statistically significant for: 24 h SBP, 24 h DBP respectively HR 1.02 (IC1.00-1.03); 1.03 (IC1.01-1.05); Day DBP 1.02 (IC 1.00-1.05); Night SBP, Night DBP, Systolic BP dipping, Diastolic BP dipping respectively HR 1.02(IC1,01-1.03);1.03(IC1.01-1.05);0.96 (IC 0.94-0.98); 0.96 (IC 0.94-0.99) When DBP dipping was adjusted to night DBP, night DBP remains significant and DBP dipping loses respectively HR 1.03(IC 1.00-1.05) and 0.99(IC 0,95- 1.02). When analyzed DBP dipping by the pattern dipping (D)/non dipping (ND, (ND-35 D-198), in a crosstabs analysis, those with event ND pattern was found in 71% and 28,6 % with no event(X2 6.9 p < 0,05). In a survival curve free of events, the presence of the diastolic dipping ND_D pattern, ND was associated to a worst prognosis (log rank 11.2 p < 0.001) Conclusions: Night diastolic values are the best prognosis for prediction of events related to outcomes in pregnant woman's with hypertension, special DBP. Casual BP and even home ambulatory blood pressure are scanty for this period.