Home blood pressure levels in pregnant women with chronic hypertension.

OBJECTIVE: To explore the difference between office and home blood pressure (BP) monitoring in normotensive and hypertensive pregnant women. METHODS: We compared the mean of 1 week home BP with office BP, measured by aneroid devices, in 20 normotensive women (68 BP assessments) and 100 women with mild essential chronic hypertension without superimposed gestational hypertension (429 BP assessments). Different approaches were used including the Bland-Altman method to investigate the discrepancies between office and home BP. RESULTS: Systolic office BP in normotensive women (p = 0.004) and diastolic office BP in hypertensive women (p = 0.001) were lower than home BP. The concordance between office and home BPs was better for diastolic BP than for systolic BP. Only a small number of hypertensive women presented home BP >or=135/85 mm Hg. CONCLUSIONS: In our study population, the concurrence between office and home BPs is good with the exception of systolic BP in normotensive women. Home blood pressure measurement criteria used in nonpregnant individuals are not adequate in pregnancy.     

Blood Pressure Assessments in Different Subtypes of Hypertensive Pregnant Women: Office Versus Home Patient- or Nurse-Measured Blood Pressure

Objective:?To explore the difference between distinct methods of assessing blood pressure (BP) in pregnant women with different hypertensive disorders.?Methods:?We compared office BP to home patient- and nurse-measured diastolic BP in pregnant women with essential chronic hypertension (CH), preeclampsia (PE) and isolated hypertension (IOH).?Results:?Office BP was lower or similar to home patient- and nurse-measured BP in women with CH. Office BP was higher than home patient-measured BP in women with PE and in women with IOH (p < 0.0001). Nurse-measured BP was higher than patient-measured BP in women with PE (p < 0.01).?Conclusions:?BP assessments in women with PE are significantly influenced by the environment, which should be considered in managing these women.     

Rapid Assessment of Blood Pressure in the Obstetric Day Unit Using Microlife MaM Technology

Objective: To compare MaM technology with current methods of assessing blood pressure (BP) over time on the obstetric day unit. Background: It is recommended that the average of repeated measures is used to confirm hypertension in pregnancy. The Microlife 3AC1 is a validated oscillometric device featuring “MaM” mode using the average of at least 3 BP readings 15 seconds apart. This allows rapid assessment of BP. The difference between each measurement is calculated and influences the percentage contribution to the final average reading. We compared MaM with readings taken in a conventional manner. Methods: Blood pressure was measured in 30 hypertensive pregnant patients recruited from the obstetric day unit of a large teaching hospital. Single BP measurements were taken at 0, 15, 30, 60, and 90 minutes using the Microlife BP 3BT0-A[2]. Simultaneous measurements (in the opposite arm) were also taken at 0 and 90 minutes using MaM technology. Results: Systolic BP fell over 90 minutes (p = 0.035) compared with the first single reading, but diastolic BP did not (p = 0.54). The difference between the first MaM and the first single reading was significantly different for systolic BP (5.6 mm Hg, p = 0.017), but not for diastolic (0.6 mm Hg, p = 0.39). The mean of all single readings and the first MaM reading were similar for both systolic and diastolic BP (SBP:0.3 mm Hg, p = 0.75, DBP: 0.2 mm Hg, p = 0.87). Conclusions: White-coat hypertension exists for systolic BP in the obstetric day unit. The MaM technology allows rapid and accurate characterization of blood pressure equivalent to repeated measures over 90 minutes.     

The Use of 24-Hour Ambulatory Blood Pressure Monitor (ABPM) in the Diagnosis of Hypertensive Disorders in Pregnancy

Objective: To evaluate hypertensive pregnant women by 24-h ambulatory blood pressure monitoring (ABPM) and to compare results with those obtained at the office.

Methods: The study population consisted of 17 women with preeclampsia (PE), 15 with mild chronic hypertension (CH), and a control group of 15 normotensive pregnant women. All the patients were evaluated by 24-h ABPM during the third trimester of pregnancy.

Results: Diastolic blood pressure (DBP) measured by daytime ABPM in patients with PE or CH was significantly lower than that measured at the office. In each group, the mean values of nighttime ABPM were significantly lower than the mean of daytime office measurements. In the PE group, a significant decline in systolic blood pressure (SBP) and DBP evaluated by nighttime ABPM was observed. In CH, the decline was significantly smaller and less pronounced than in PE.

Conclusion: 24-h ABPM appears to be a promising method for the evaluation of hypertensive disorders of pregnancy     

Blood pressure in late pregnancy and work outside the home

OBJECTIVE: To assess maternal blood pressure (BP) responses to working outside the home in late pregnancy, using 24-hour ambulatory BP monitoring. METHODS: Our paired observational study involved 24-hour ambulatory BP monitoring of 100 normotensive women (51 primiparas, 49 multiparas) on work and nonwork days. Mean BP differences were calculated for working, postworking, sleeping, and 24-hour periods on both days. Main outcome measures were BP differences between work and nonwork days and subsequent pregnancy hypertension. Comparisons in BP between work and nonwork days were done with Student paired t test. Comparisons between study subgroups were done with unpaired t test. Potential predictors of change in BP were examined using multiple linear regression. RESULTS: During job time, BP was significantly higher on work days than on nonwork days. The mean increase in BP associated with work was 2.6 mmHg (systolic BP, P <.001), 2.8 mmHg (diastolic BP, P <.001), and 2.9 mmHg (mean arterial BP, P <.001). Those observations were independent of parity. More than 10% of our subjects had increased mean arterial BP of 10 mmHg or more during job time on work days compared with nonwork days. Higher absolute BP levels (regression coefficient 0.21, P =.04) and greater perceived job stress (regression coefficient 1.34, P =.04) correlated positively with BP increases at work. Twelve women developed hypertension. Those women had a larger increase on work days in mean systolic (6.6 mmHg compared with 2.1 mmHg, P =.013), mean diastolic (6.4 mmHg compared with 2.3 mmHg, P =.014), and mean arterial (7.4 mmHg compared with 2.3 mmHg, P =.002) BP compared with normotensive women. The magnitude of BP responses to work was a significant predictor of pregnancy hypertension, independent of absolute BP level. CONCLUSION: Blood pressure increased in women when they worked outside the home. The effect of maternal work is important when treating pregnancy hypertension. Ambulatory BP monitoring makes assessment of maternal BP responses to work a practical clinical option.     

Intrauterine Growth Restriction in Spontaneously Hypertensive Rats

Objective: To determine whether a rise in systolic blood pressure (SBP) ≥ 30 mm Hg and/or diastolic blood pressure (DBP) ≥ 15 mm Hg in the absence of hypertension during pregnancy is associated with adverse pregnancy outcomes. Method: We conducted a retrospective, longitudinal study of 1498 pregnant women without hypertension or proteinuria in the first trimester. The blood pressure levels measured during the first (7.8 ± 2.3 weeks), second (20.7 ± 1.2 weeks), and third trimesters (38.6 ± 1.5 weeks) were analyzed. The perinatal outcome was compared between women who exhibited a rise in SBP ≥ 30 mm Hg and/or DBP ≥ 15 mm Hg during pregnancy (large Δ BP group) and women who did not (small Δ BP group) using one way analysis of variance, chi‐square test, or Fisher's exact test. The contribution of gestational hypertension and a large Δ BP to the development of adverse pregnancy outcomes was evaluated using multivariate logistic regression analysis. Results: Of 1441 women who remained normotensive (SBP < 140 mm Hg and DBP < 90 mm Hg) during pregnancy, 238 (16.5%) and 1203 (83.5%) belonged to the large Δ BP and small Δ BP groups, respectively. There were no significant differences between the two groups in the occurrence rate of gestational proteinuria, preterm deliveries, low‐birth‐weight infants, or small‐for‐gestational age infants. A large Δ BP was not a risk factor in itself for the occurrence of gestational proteinuria or small‐for‐gestational age infants after controlling for the effect of gestational hypertension. Conclusion: A rise in SBP ≥ 30 mm Hg and/or DBP ≥ 15 mm Hg is not a risk factor of adverse outcome among women who remain normotensive during pregnancy.     

Hemodynamic Adaptation during Pregnancy in Chronic Hypertension

Objective: To assess hemodynamic and NT-proANP changes in women with chronic hypertension during pregnancy. Methods: Stroke volume index (SI), heart rate (HR), cardiac output index (CI), systemic vascular resistance index (SVRI), pulse wave velocity (PWV), and left cardiac work index (LCWI) were measured using whole-body impedance cardiography. Systolic blood pressure (SAP), mean arterial pressure (MAP), diastolic blood pressure (DAP), and pulse pressure (PP) were also measured. Arterial compliance was defined as the SI-to-PP ratio (SI/PP). Hemodynamic parameters and NT-proANP concentrations were assessed during the early and late second trimester, the third trimester, and after delivery in 20 women with essential hypertension and 30 normotensive women. Results: Arterial blood pressure, SVRI, and PWV remained higher during the whole study period in chronic hypertensive compared with healthy pregnancies. In the early second trimester, women with chronic hypertension had significantly lower SI and NT-proANP concentrations than did normotensive women. Conclusion: The hemodynamics of chronic hypertension during pregnancy are characterized by persistent high vascular resistance. Lower SI and NT-proANP values found in chronic hypertensive pregnancies during the early second trimester may suggest a reduced intravascular volume increase during pregnancy.     

Accuracy of Automated Blood Pressure Recorders in Pregnancy

Summary: Automated blood pressure recorders are used with increasing frequency by pregnant women, mostly without proper evaluation of their accuracy. We compared blood pressures (BP) recorded by 2 automated noninvasive devices, the Spacelabs 90207 ambulatory blood pressure monitor and the OMRON HEM 705 CP portable selfinitiated device, with blood pressures recorded by routine sphygmomanometry in 79 pregnant women either considered 'at risk' for preeclampsia or with mild hypertension in pregnancy. The Spacelabs device tended to overestimate systolic BP by a mean 11 (SD = 8) mmHg and diastolic BP by 5 (SD = 7) mmHg for phase 5 pressure (p < 0.001) but was similar to routine BPs for diastolic phase 4 pressures. The OMRON device tended to underestimate diastolic (phase 4) pressure by 4 (SD = 6) mmHg (p < 0.001) but gave similar systolic and diastolic (phase 5) pressures to routine sphygmomanometry. However, for both devices there was considerable individual patient variability in accuracy. When using these devices to record a limited number of blood pressure recordings, as in this study, we suggest that individual comparison with mercury sphygmomanometry be made in each pregnant woman before accepting the validity of these recordings.     

Circadian Pattern of Blood Pressure in Normal Pregnancy and Preeclampsia

Aims &; Objective

To find out the circadian pattern of blood pressure in normotensive pregnant women and in women with preeclampsia.

Method

A cross-sectional prospective observational case control study. Blood pressure was sampled in thirty-five normotensive pregnant women (control) and thirty five preeclamptic women (study group) by using non-invasive automatic ambulatory blood pressure monitoring machine for 72 h.

Results

Blood pressure (BP) was not constant over 24 h period and it oscillated from time to time in control group. BP was maximum during early part of afternoon. However, in preeclampsia besides quantitative increase in BP, circadian BP oscillations were less pronounced and in around 50% subjects BP was maximum during evening and night hours.

Conclusion

Both systolic and diastolic BP showed definite reproducible circadian pattern in both preeclamptic and normotensive pregnant women. This pattern both quantitatively and qualitatively was different in preeclamptic women. Standardized 24 h BP monitoring allows quantitative and qualitative evaluation of hypertensive status and is important for timing and dosing of antihypertensive medications.     

Effect of regular exercise on blood pressure in normotensive pregnant women. A randomized controlled trial

Objective: To evaluate the effect of regular exercise on maternal arterial blood pressure (BP) at rest and during uphill walking, in healthy former inactive pregnant women. Methods: A single-blind, single-center, randomized controlled trial including 61 out of 105 healthy, inactive nulliparous pregnant women, initially enrolled in a controlled trial studying the effect of 12 weeks of aerobic exercise (60 min 2/week) on maternal weight gain. Primary outcome was the mean adjusted difference in change in resting systolic and diastolic BP from baseline to after intervention. Secondary outcome was the mean adjusted difference in change in systolic BP during uphill treadmill walking at critical power. Measurements were performed prior to the intervention (gestation week 17.6 ± 4.2) and after the intervention (gestation week 36.5 ± 0.9). Results: At baseline, resting systolic and diastolic BP was 115/66 ± 12/7 and 115/67 ± 10/9 mmHg in the exercise (n = 35) and control group (n = 26), respectively. After the intervention, resting systolic BP was 112 ± 8 mmHg in the exercise group and 119 ± 14 mmHg in the control group, giving a between-group difference of 7.5 mmHg (95% CI 1.5 to 12.6, p = 0.013). Diastolic BP was 71 ± 9 and 76 ± 8 mmHg, with a between-group difference of 3.9 mmHg (95% CI ?0.07 to 7.8, p = 0.054). During uphill treadmill walking at critical power, the between-group difference in systolic and diastolic BP was 5.9 mmHg (95% CI ?4.4 to 16.1, p = 0.254) and 5.5 mmHg (95% CI –0.2 to 11.1, p = 0.059), respectively. Conclusions: Aerobic exercise reduced resting systolic BP in healthy former inactive pregnant women.     

Ambulatory blood pressure measurements in mid-pregnancy and development of hypertensive pregnancy disorders

Objective: To explore if blood pressure (BP) readings over 24?h is a useful addition to uterine artery Doppler to screen for hypertensive disorders. Methods: In a prospective observational study, we invited nulliparous women with abnormal and normal uterine artery Doppler but normal BP at the time of their routine anomaly scan. BP was measured by the woman using automated apparatus at five specified time intervals over 24?h at 22–24 weeks. Pregnancy outcome was retrieved from delivery suite records, discharge summaries, and letters to general practitioners if necessary. Logistic regression was used to explore the contribution of uterine artery Doppler and BP measurements towards the development of pre-eclampsia. Results: Data were available from 52 women with abnormal and 48 women with normal uterine artery Doppler. Thirteen women developed hypertension in pregnancy. Significant difference was found in the BP of women who did or did not develop hypertensive disorders. BP recordings showed the diurnal variation. Both uterine artery Doppler mean PI and BP showed significant correlation with future development of hypertension. Conclusions: Women can self-measure BP at home. BP readings show diurnal variation. There are significant differences in BP of women who do and do not develop hypertension later in the pregnancy. Use of home BP monitoring over 24?h of the day in mid-pregnancy is unlikely to add to the use of uterine artery Doppler and a one-off BP reading for future development of hypertension in pregnancy.     

Time Poor: Rushing Decreases the Accuracy and Reliability of Blood Pressure Measurement Technique in Pregnancy

Background: In pregnancy, absolute blood pressure (BP) limits define preeclampsia. Therefore, BP in pregnancy should be measured accurately and in accordance with accepted guidelines. Accuracy of BP readings determined by rate of cuff deflation was analyzed. This study also investigated the compliance of clinical staff at Royal Prince Alfred Hospital, Australia, to guidelines for BP measurement. Methods: The study was an observational trial of 98 normotensive antenatal or recently postnatal patients. Two BP readings were taken, each with fast (>5 mm Hg/sec) and slow (≤2 mm Hg/sec) descent of mercury and compared by Bland-Altman analysis. Also, BP techniques used by junior doctors, specialist obstetricians, and midwives were compared using a 9-point scale. Findings: Australian national guidelines recommend slow descent of mercury. Fast descent underestimated the systolic BP by 9 mm Hg (95% confidence interval [CI], ?23 to +5 mm Hg) (p < 0.001). Fast descent measured the diastolic BP within 2 mm Hg (95% CI, ?10 to +14 mm Hg) (not different, p = 0.151). Accuracy of fast cuff deflation was 28% for systolic BP and 50% for diastolic BP for <5 mm Hg, and respectively, 64% and 68% for <10 mm Hg, 84% and 80% for <15 mm Hg and 91% and 87% for <20 mm Hg. Compliance with guidelines was greatest for specialists and midwives (p = 0.001) and their most commonly missed feature (76% to100%) was slow cuff deflation. Interpretation: Rapid cuff deflation underestimates the systolic BP compared to accepted guidelines (≤2 mm Hg/sec). Medical and midwifery staff may not follow accepted guidelines for BP measurement, particularly with regard to rate of cuff deflation. Potential misdiagnosis and under-treatment of patients with hypertension may compromise pregnancy outcomes.     

LONG-TERM PROGNOSIS OF HYPERTENSION IN PREGNANCY

Objectives To assess the prevalence of subsequent hypertension in women with hypertensive pregnancies and evaluate it according to the subclassifications of hypertension in pregnancy.

Methods A survey was carried out in 476 women with hypertensive pregnancies (cases) and 226 normotensive controls delivered between 1973 and 1991 in a tertiary-level teaching hospital. They were invited to participate by mail and 273 cases (57%) and 86 controls (38%) completed the analysis. Outcomes assessed were prevalences of hypertension, diabetes, and hypercholesterolemia, together with cardiovascular morbidity.

Results Among responders, age and parity were similar in both groups although follow-up time was longer in controls. Subsequent hypertension was more frequent within cases. After excluding chronic and unclassifiable hypertension, the mean blood pressure was higher in all other forms of pregnancy hypertension (103 ± 13 mm Hg versus 94 ± 13 mm Hg, p < 0.001); long-term hypertension prevalence was 45% in cases and 14% in controls [odds ratio (OR) = 5.1; 95% confidence interval (95% CI) = 2.5–9.8; p < 0.001]. There were no differences with respect to the prevalences of subsequent diabetes or hypercholesterolemia. Remote hypertension was more common following gestational hypertension (54%) than in preeclampsia (38%), eclampsia (14%), or normotensive cases (14%) (OR for gestational hypertension versus normotensives = 7.2; 95% CI = 3.4–14.8, p < 0.001, and OR for preeclampsia versus normotensives = 3.7; 95% CI = 1.7–7.9, p < 0.001).

Conclusions After an average of 13.6 years since the index pregnancy, women with hypertensive pregnancies have an increased risk of subsequent hypertension. Gestational hypertension is the hypertensive disorder of pregnancy with the highest incidence of subsequent hypertension. Women with preeclampsia have a greater tendency to develop hypertension than women with normotensive pregnancies. By contrast, women with eclampsia do not.

     

Effect of different hormone replacement therapy regimens on circadian blood pressure profile and active renin in postmenopausal women

Hormone replacement therapy (HRT) was considered as main prevention of cardiovascular disease (CVD) in postmenopausal women. Mechanisms of vasoprotective effect of this treatment are complex. However, recent data give rise to some uncertainties about HRT benefits and risks. Little is known about the effects of oral and transdermal HRT regimens on the renin-angiotensin-aldosterone system (RAS) and blood pressure (BP). This 3-month study comprised 28 menopausal women (age range 45-55 years) divided into two groups: Group 1: 12 normotensive women with natural occurrence of menopause receiving oral treatment with Climen^® (Schering) containing estradiol valerate and cyproterone acetate; Group 2: 16 normotensive women with surgically induced menopause receiving transdermal application of Climara^® (Schering) containing 17β-estradiol. There were no significant differences in office BP before and after treatment with Climara or Climen. However, ambulatory monitoring showed a significant fall in systolic BP (day-time, night-time and total 24-h) when estradiol alone was used. A similar trend towards lower values of systolic BP that was significant only for the night-time BP was observed after treatment with Climen. There were no significant changes in diastolic BP after both treatment regimens. Heart rate (day-time and 24-h) was significantly lower after transdermal estradiol treatment. There was no significant change in active renin after both treatment regimens. The present study showed that both treatment regimens resulted in lower ambulatory BP in normotensive postmenopausal women with more notable reduction in night-time BP. Increase in nocturnal dipping may account in part for the beneficial cardiovascular effects of HRT including decreased end-organ damage.     

Cardiovascular responses to the change from the left lateral to the upright position in pregnant hypertensives

Objective: To evaluate by non-invasive means, the autonomically mediated changes in heart rate and blood pressure in response to postural change in pregnancy. Method: Ninety-one patients were studied, of whom 17 were non-pregnant controls, 21 were normotensive parturients, 22 had non-proteinuric hypertension, and 31 were pre-eclamptics. In all patients the heart rate and blood pressure response to the change from the left lateral to the erect position was measured non-invasively, during the third trimester in the pregnant groups. Results: The change from the left lateral to the erect position induced significantly greater mean changes (increases) in systolic blood pressure in the normotensive pregnant (PC) women than all other groups (P<0.05). Pre-eclamptic patients (PE) exhibited significantly less of an increase in systolic blood pressure than the non-proteinuric hypertensive (H) group. Both the H and PC groups showed significantly greater increases in diastolic pressure than the non-pregnant (NP) group. PE patients had a significantly smaller increase in diastolic pressure than the H group. There were no significant differences between heart rate changes when comparing the PC, NP and H groups. The PE group exhibited a significantly greater increase in heart rate on adopting the erect position than all other groups. Conclusions: Pre-eclamptics exhibit smaller changes in blood pressure than normotensive pregnant patients and non-proteinuric hypertensives on standing, while producing an exaggerated heart rate response, indicating altered autonomic compensatory mechanisms in these patients.     

Postpartum Course of Gestational Hypertension and Preeclampsia

Background: New onset hypertension (gestational hypertension and preeclampsia) complicates 6–8% of pregnancies and usually resolves postpartum, but the time to normalization of blood pressure (BP) in the postpartum period is not known. Methods. We performed a retrospective cohort study of previously normotensive women who developed gestational hypertension or preeclampsia, and determined the number of weeks postpartum to BP normalization. Results: 62 women with no history of hypertension prior to pregnancy were included, age 35.3 ± 7.1 years. Hypertension developed at gestational age 15–40 weeks; 45% developed hypertension within 3 days of delivery, 52% developed hypertension 1–22 weeks prior to delivery, and 5% had onset only postpartum. Infants were born at gestational age 35.15 ± 4.7 weeks. Average BP at treatment initiation was 162/95 mm Hg. Preeclampsia and/or HELLP syndrome was diagnosed in 48%. Most were treated with BP medication in the puerperium. In those whose BP normalized, time to normalization was 5.4 ± 3.7 weeks. Those who remained hypertensive beyond 6 months (19%) were older (38.8 years vs. 34.4, p = 0.018). Three women had secondary hypertension; primary hyperaldosteronism was diagnosed in 2 women and renovascular hypertension in 1. Conclusion: Hypertension presenting in pregnancy normalized postpartum in 81% of this cohort, in most by 3 months. Those who remained hypertensive at 6 months postpartum tended to be older than patients whose BP normalized. Secondary hypertension was detected and surgically corrected in 3 patients. Further studies are needed to characterize those most likely to benefit from postpartum antihypertensive treatment and to guide management.     

Does Uric Acid Provide Information About Maternal Condition and Fetal Outcome in Pregnant Women with Hypertension?

Objective: To evaluate associations between maternal serum uric acid (UA) levels, maternal status, and fetal outcome. Methods: Maternal UA, urinary protein-creatinine ratio (P/C), blood pressure (BP), gestational age at delivery, and birth weight were evaluated in hypertensive pregnant women (n = 58). These were divided into two groups: high UA (≥357 μmol/L) or normal UA (<357 μmol/L). Results: Maternal diastolic BP and P/C ratio were higher in pregnant women with elevated UA levels. Systolic BP, gestational age and birth weight were not significantly different. Conclusion. UA equal or above 357 μmol/L in pregnant hypertensive women was associated with proteinuria and diastolic BP, but not with fetal outcome.     

Use of automated home blood pressure monitoring in pregnancy: is it safe?

OBJECTIVE: The purpose of this study was to investigate the relationship between blood pressure that is measured with the automated blood pressure monitor, Omron HEM-705CP (Omron Corporation, Tokyo, Japan), and mercury sphygmomanometry in normotensive and preeclamptic pregnant women. STUDY DESIGN: Healthy pregnant women (n = 101 women) underwent mercury and home Omron HEM-705CP monitor blood pressure measurements at 10 to 14, 19 to 22, 27 to 30, and 35 to 37 weeks of gestation and 5 to 9 weeks after delivery. After routine mercury blood pressure recordings that were taken by midwives, women with preeclampsia (n = 45 women) measured their own blood pressure using an Omron HEM-705CP monitor (n = 212 recordings). In the longitudinal cohort, mean +/- 2 SD were calculated for blood pressure levels throughout pregnancy. Individual variation in home Omron minus office mercury throughout pregnancy was determined. In preeclampsia, back-to-back blood pressure measurements by the two methods were correlated and quantified as being within 5, 10, and 15 mm Hg. Bland-Altman plots were calculated, and the sensitivity of the Omron HEM-705CP monitor to detect hypertension that was identified by mercury sphygmomanometry was evaluated. RESULTS: At 10 to 14, 19 to 22, 27 to 30, and 35 to 37 weeks of gestation, the upper limits for normal systolic blood pressure levels with the use of home Omron HEM-705CP monitor measurements were 132, 130, 133, and 138 mm Hg and for diastolic blood pressure levels were 82, 79, 81, and 88 mm Hg, respectively. For women who were normotensive and had preeclampsia (although group mean blood pressure values by mercury sphygmomanometry and Omron HEM-705CP monitor were similar), there were marked individual differences (90% of mild hypertension (140/90 mm Hg) but missed one third of hypertension with a blood pressure level of >160/100 mm Hg by mercury sphygmomanometry. CONCLUSION: Clinicians should be aware of the potential differences between blood pressure measurements with mercury sphygmomanometers and Omron HEM-705CP monitors in pregnancy. The Omron HEM-705CP monitor should not be used to monitor hypertension in preeclampsia.     

P-wave and QT dispersion in hypertensive disorders of pregnancy

Abstract

Aim: To compare P-wave and QT dispersion values in hypertensive disorders of pregnancy and controls and also in preeclampsia, chronic hypertension, and gestational hypertension separately.

Material and methods: We included 140 hypertensive pregnants and 110 healthy age-matched pregnants in this study. The hypertensive pregnants were divided into three subgroups: preeclampsia (n?=?43), chronic hypertension (n?=?51), and gestational hypertension (n?=?46). P-wave and QT dispersion values were compared between groups.

Results: Hypertensive pregnants had higher P-wave (41.74?±?5.51 vs. 37.73?±?5.62, p?<?.001) and QTc dispersion (45.44?±?7.62 vs. 39.77?±?8.34, p?<?.001) values. In subgroup analysis, P-wave dispersion and QTc dispersion were different between preeclamptic, chronic hypertensive, and gestational hypertensive patients. Also, they were significantly higher in chronic hypertension as compared to gestational hypertension and they were higher in preeclampsia than in gestational hypertension. No difference was found according to these parameters between preeclampsia and chronic hypertension. In correlation analysis, both P-wave dispersion and QTc dispersion were positively correlated with systolic (r?=?0.409, p?<?.001 and r?=?0.306, p?<?.001) and diastolic blood pressure (r?=?0.390, p?<?.001 and r?=?0.287, p?<?.001) which are main clinical determinants of hypertensive disorders.

Conclusion: In clinical practice, chronic hypertensive pregnants are generally followed up in their future life for cardiovascular disorders. Also, we recommend that we must inform and follow preeclamptic patients for future cardiovascular diseases.     

Blood pressure changes across gestation in patients with twin pregnancies

Abstract

Objective: To report blood pressure (BP) across gestation in patients with twin pregnancy.

Methods: Historical cohort of all twin pregnancies managed by one maternal-fetal medicine practice from 2005 to 2012. Patients with chronic hypertension were excluded. We reviewed all outpatient BP measurements taken during pregnancy and compared systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) for every 2-week interval starting at 6?weeks. All BP measurements were taken manually in the seated upright position.

Results: There were 520 patients with twin pregnancies managed over the study period, 19 (3.7%) were excluded for chronic hypertension, leaving 501 patients for analysis. There were a total of 4985 BP measurements (9.95 per patient) during pregnancy. Starting at 6?weeks’ gestation, the SBP, DBP and MAP remained stable until 30?weeks’ gestation, when all three began to rise significantly until 38?weeks (p?<?0.001). There was no drop in BP in the second trimester. The 95th percentile for systolic BP did not exceed 121?mmHg until 30?weeks and the 95th percentile for diastolic BP did not exceed 80?mmHg until 34?weeks. The 4?- to 10-week postpartum DBP and MAP were significantly higher than the initial DBP and MAP <10?weeks.

Conclusions: In patients with twin pregnancies, the BP remains stable from 6?weeks until 30?weeks, at which time it begins to rise steadily. The 95th percentile for SBP and DBP prior to 30?weeks are ～120 and 80?mmHg, respectively.