Is home blood‐pressure monitoring in hypertensive disorders of pregnancy consistent with clinic recordings?

Abstract

Our study shows that, in women with HDP, blood pressure measured at home is lower than that measured in a clinic setting. This is consistent with observations in non-pregnant adults, in whom home and ambulatory monitoring of hypertensive patients is recommended. As such, HBPM has the potential to reduce the number of false-positive diagnoses of severe hypertension and unnecessary medical interventions in women with HDP. This must be carefully weighed against the risk of missing true-positive diagnoses. Prospective studies investigating the use of HBPM in pregnant women are urgently needed to determine the relevant blood-pressure thresholds for HBPM, and interval and frequency of monitoring. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Cardiovascular System in Preeclampsia and Beyond

“…103 However, blood pressure values and incidence of severe hypertension differ with home and clinic monitoring during pregnancy, and optimal cutoffs for action is subject to debate currently. 104 Although preeclampsia should be regarded as an important risk factor for cardiovascular disease in women, it also presents a unique opportunity to identify and potentially intervene to ameliorate the adverse effects of preeclampsia on immediate postpartum maternal health.…”

Ambulante und häusliche Blutdruckmessung bei hypertensiven Schwangeren

“…Trotz bisher unzureichender Evidenz aus prospektiven randomisierten Studien gelten häusliche Blutdruckwerte (Durchschnittswerte über 3-6 Tage) ≥ 135 mmHg systolisch und/oder ≥ 85 mmHg diastolisch als Hypertonie [5,9,30], allerdings fehlen bisher ebenfalls aussagekräftige Studien zur Korrelation zwischen dem optimalen Blutdruckgrenzwert und mütterlichen Komplikationen sowie dem perinatalen und neonatalen Outcome [12,27,31,32]. Bei erheblicher Heterogenität zwischen den Studien ist die Datenlage, in wie weit häusliche vs. in Praxis/Klinik gemessene Blutdruckwerte bei normotensiven und hypertensiven Schwangeren voneinander abweichen, kontrovers [16,27,31,32].…”

Toward personalized management of chronic hypertension in pregnancy

“…45e47 Used to monitor the BP of unselected and pregnant women with hypertension, 48 HBPM reduces false-positive diagnoses of severe hypertension and unnecessary interventions. 49 Key considerations for HBPM use in pregnancy include pregnancy-and preeclampsia-validated BP devices, clear triggers for action by women, care pathways, and mechanisms for bidirectional communication between women and care providers.…”

“…Women receive immediate feedback to call or present for urgent care, based on the level of BP relative to set thresholds, reported symptoms, and/or proteinuria testing. 41,49 Digital technology may facilitate use of physiological variables other than BP level (eg, heart rate [HR], BP variability, hyperdynamic circulation, high vascular resistance) to predict preeclampsia and FGR; these are facilitated by the large numbers of recordings available through HBPM and availability of noninvasive cardiac output monitors. 55e57…”