Prognostic Value of Office and Ambulatory Blood Pressure Measurements in Pregnancy

Hermida, Ramón C.; Ayala, Diana E.

doi:10.1161/01.hyp.0000028978.99648.d0

Cited by 68 publications

(49 citation statements)

References 33 publications

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“…11 Against the common approach of relying on the 24-hour mean of ABPM, the combined approach of establishing tolerance intervals for the circadian variability of BP as a function of gestational age 25 and then computing the hyperbaric index (area of BP excess above the upper limit of the tolerance interval) by comparison of any patient's BP profile with those intervals, has been shown to provide high sensitivity and specificity for the early detection of pregnant women who will have subsequent development of gestational hypertension or preeclampsia 12 as well as a proper approach for the prediction of the outcome of pregnancy. 26 Results from this trial on the impact of the duration and frequency of BP sampling on the reproducibility of mean values indicate that parameters calculated from the ABPM profile are much more dependent on duration of sampling than on sampling rate. Thus, Figures 1 and 2 indicate that the 24-hour mean of BP can be better estimated by expanding the length of the monitoring span to 48 hours, even by markedly reducing the frequency of sampling up to only 1 value every 3 hours.…”

Section: Discussionmentioning

confidence: 81%

“…Gestational hypertension was defined as conventional BP values Ͼ140 or 90 mm Hg for systolic (SBP) or diastolic BP (DBP), respectively, after the 20th week of gestation, and/or a hyperbaric index (area of BP excess above the upper limit of a time-varying tolerance interval 25,26 ) consistently above the threshold for diagnosis of hypertension in pregnancy 12 after the 20th week of gestation for further corroboration. Preeclampsia was defined as gestational hypertension and proteinuria Ͼ300 mg in 24 hours of urine collection.…”

Section: Subjectsmentioning

confidence: 99%

“…Further details on the women participating in this prospective protocol on BP variability throughout gestation have been provided previously. 26,27 Inclusion criteria were the absence of any condition requiring the use of antihypertensive medication, maternal age (18 to 40 years), and gestational age (Ͻ16 weeks at the time of inclusion). Exclusion criteria were multiple pregnancy, chronic hypertension, chronic liver disease, kidney disease, any disease requiring the use of anti-inflammatory medication, diabetes or any other endocrine disease such as hyperthyroidism, and intolerance to the use of an ABPM device.…”

Section: Subjectsmentioning

confidence: 99%

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Sampling requirements for ambulatory blood pressure monitoring in the diagnosis of hypertension in pregnancy

Hermida

Ayala

2002

American Journal of Hypertension

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Abstract-Previous studies on ambulatory blood pressure monitoring as a potential screening test for hypertension in pregnancy have not carefully considered sampling requirements. We have examined the impact of duration and frequency of blood pressure sampling in the reproducibility of mean values in pregnancy. We analyzed 2430 blood pressure series sampled every 20 minutes during the day and every 30 minutes at night for 48 hours every 4 weeks from the first obstetric visit until delivery in 235 normotensive and 168 hypertensive pregnant women. Blood pressure series were decimated to generate shorter series with data sampled every 1, 2, 3, or 4 hours for 48 hours, as well as at the original rate for the first day. Reproducibility of mean blood pressure as well as sensitivity and specificity in the diagnosis of hypertension were compared between the original and the decimated series. Sensitivity and specificity of the 24-hour blood pressure mean are similar for the values calculated from the original series and for those obtained from shorter profiles up to data sampled every 3 hours but reduced by 5% to 12% when diagnosis is based on data sampled at 20-to 30-minute intervals for the first 24 hours. Results also indicate that the 24-hour blood pressure mean is better reproduced with data sampled at 3-hour intervals for 48 hours than by data sampled at 20-to 30-minute intervals for 1 day only. This study demonstrates that reproducibility of mean blood pressure values is more dependent on duration of sampling than on sampling rate. Key Words: blood pressure Ⅲ pregnancy Ⅲ hypertension, pregnancy Ⅲ preeclampsia Ⅲ blood pressure monitoring, ambulatory P regnancies complicated by hypertension contribute markedly to perinatal morbidity and mortality rates. 1 Because an elevated blood pressure (BP) after 20 weeks of gestation in a previously normotensive woman is common to the definition of both gestational hypertension and preeclampsia, 2,3 the issue of whether the development of these complications may be predicted on the basis of BP obtained during conventional antenatal visits has been addressed in several retrospective as well as prospective studies. 4 -7 Recent studies have tried to overcome the poor results from isolated conventional BP measurements in detecting hypertensive complications in pregnancy by relying on ambulatory BP monitoring (ABPM). 8 -17 By the use of ABPM, differences between healthy and complicated pregnancies in the circadian pattern of BP, previously documented for the second trimester of pregnancy, 9 can be observed as early as in the first trimester of pregnancy, quite before the actual clinical diagnosis of gestational hypertension or preeclampsia takes place for most pregnant women investigated. 15,17 As in the general nonpregnancy practice, the most common approach has been to rely for diagnosis on the arithmetic mean of all values determined by ABPM. However, the use of the 24-hour mean of BP does not provide a proper approach for an individualized early diagnosis of hypertension in pr...

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Section: Discussionmentioning

confidence: 81%

Section: Subjectsmentioning

confidence: 99%

Section: Subjectsmentioning

confidence: 99%

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Sampling requirements for ambulatory blood pressure monitoring in the diagnosis of hypertension in pregnancy

Hermida

Ayala

2002

American Journal of Hypertension

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“…It is well recognized that a relatively large proportion of pregnant women may have masked gestational hypertension, undetected by office BP measurements, but revealed by specific BP index or circadian patterns computed with ambulatory BP monitoring. [31][32][33] Notably, pregnant women at increased risk of hypertension disorders tend to have higher night-time ambulatory BP than women without development of hypertension complications during pregnancy. 33 At the same time, night-time ambulatory BP is an independent predictor of LA size in hypertensive patients.…”

Section: Discussionmentioning

confidence: 99%

Additive value of standard ECG for the risk prediction of hypertensive disorders during pregnancy

Angeli

Verdecchia²,

Narducci

et al. 2011

Hypertens Res

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Prediction of hypertensive complications during pregnancy remains limited, especially in healthy and initially normotensive women. We conducted a prospective screening study for hypertensive complications in pregnant women. We studied 221 nulliparous healthy and normotensive women with singleton pregnancies whose first routine visit was carried out before the twelfth week of gestation. We tested several demographic, clinical and laboratory variables as predictors of a composite pool of prespecified events, including gestational hypertension, preeclampsia or eclampsia. We analyzed the potential additive role of ECG in the identification of women at increased risk of hypertensive disorders. Mean age at entry was 30 years. During pregnancy, there were 28 prespecified events (22 women with gestational hypertension, 5 with preeclampsia and 1 with eclampsia). In univariate analyses, blood pressure (BP), weight, body mass index (BMI) and left atrial (LA) abnormality detected by ECG in lead V 1 showed an association with the risk of hypertensive disorders (all Po0.05). In a multivariable analysis, only mean BP (OR: 3.08, 95% confidence interval (CI): 1.61-5.92; P¼0.001 for each 10 mm Hg increase) and LA abnormality in lead V 1 (OR: 4.35, 95% CI: 1.84-10.31; P¼0.001) were independent predictors of hypertensive disorders. The final model discriminated well between women who developed hypertensive disorders and women who remained normotensive (AUC¼0.75; 95% CI: 0.67-0.84; Po0.0001). This study suggests that standard ECG is valuable to refine risk stratification for hypertensive disorders in initially normotensive pregnant women. LA abnormality, easily detected by simple visual inspection of the traditional ECG, and mean arterial pressure (MAP), allows a rapid and effective risk stratification for hypertensive disorders.

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“…Furthermore, Hermida, et al [30] have shown that, in pregnancy, the hyperbaric index (area of BP excess above the upper limit of a time-specified tolerance interval) derived from ABPM was superior to office measurements for predicting the outcome of pregnancy.…”

Section: Ecgmentioning

confidence: 99%

Risk Stratification Models to Predict Hypertensive Disorders of Pregnancy: Additive Value of Standard Electrocardiography

Trapasso¹,

Angeli²,

Verdecchia³

et al. 2017

Int J Womens Health Wellness

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Hypertension disorders complicate up to 10%-11% of all pregnancies and remain leading causes of poor outcome, including placental abruption, organ failure, cerebrovascular accident and disseminated intravascular coagulation. These disorders are also associated with increased risk of perinatal death, fetal intrauterine growth restriction, and prematurity/preterm delivery.Epidemiological evidences supporting the worse prognosis associated with hypertension in pregnancy provide a strong basis for developing perinatal morbidity and mortality risk prediction models.Of the many risk markers for hypertensive disorders, some are known at booking and increase the risk of hypertensive disorders two-to four-fold. They include pre-existing hypertension, diabetes mellitus and renal disease, previous preeclampsia, antiphospholipid antibody syndrome, overweight/obesity, inter-pregnancy interval ≥ 10 years, and multiple pregnancies.Recently, the additive value of some instrumental techniques (including uterine artery Doppler velocimetry, electrocardiography and ambulatory blood pressure monitoring) and their combinations with maternal factors and biochemical markers to refine risk stratification for hypertensive disorders in pregnancy has also been evaluated.The main aim of our systematic review was to summarize the present state of knowledge in this active area of broad interest. Specifically, we aimed to provide an overview of recent contributions on the role of electrocardiography for the identification of women at increased risk of hypertensive complications during pregnancy.Briefly, current Guidelines recommend performing a 12-lead electrocardiogram in order to evaluate the presence of left ventricular hypertrophy in pregnant women. Nevertheless, some abnormal electrocardiographic patterns, particularly in the first trimester of pregnancy, may increase the risk of maternal and neonatal complications. In this context, left atrial abnormalities in lead V 1 have been suggested as independent predictors of hypertensive disorders and other pregnancy complications including fetal growth restriction, HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, placental abruption, stillbirth, premature delivery and neonatal death.Available data support the notion that risk stratification for hypertensive disorders might be improved in the first-trimester of pregnancy using standard electrocardiography in combination with maternal characteristics and history. An effective screening for hypertensive disorders is useful to identify women that would potentially benefit from a closer surveillance and from prophylactic pharmacological interventions.

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Prognostic Value of Office and Ambulatory Blood Pressure Measurements in Pregnancy

Cited by 68 publications

References 33 publications

Sampling requirements for ambulatory blood pressure monitoring in the diagnosis of hypertension in pregnancy

Sampling requirements for ambulatory blood pressure monitoring in the diagnosis of hypertension in pregnancy

Additive value of standard ECG for the risk prediction of hypertensive disorders during pregnancy

Risk Stratification Models to Predict Hypertensive Disorders of Pregnancy: Additive Value of Standard Electrocardiography

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