Ambulatory Blood Pressure Monitoring for Diagnosis and Management of Hypertension in Pregnant Women

Abstract

Hypertension disorders during pregnancy has a wide range of severities, from a mild clinical condition to a life-threatening one. Currently, office BP is still the main method for the diagnosis of hypertension during pregnancy. Despite of the limitation these measurements, in clinical practice office BP of 140/90 mmHg cut point is used to simplify diagnosis and treatment decisions. The out-of-office BP evaluations are it comes to discarding white-coat hypertension with little utility in practice to rule out masked hypertension and nocturnal hypertension. In this revision, we analyzed the current evidence of the role of ABPM in diagnosing and managing pregnant women. ABPM has a defined role in the evaluation of BP levels in pregnant women, being appropriate performing an ABPM to classification of HDP before 20 weeks of gestation and second ABMP performed between 20–30 weeks of gestation to detected of women with a high risk of development of PE. Furthermore, we propose to, discarding white-coat hypertension and detecting masked chronic hypertension in pregnant women with office BP > 125/75 mmHg. Finally, in women who had PE, a third ABPM in the post-partum period could identify those with higher long-term cardiovascular risk related with masked hypertension.

When and how to use ambulatory blood pressure monitoring and home blood pressure monitoring for managing hypertension

“…Moreover, women with WCH before 20 weeks are associated with worse perinatal and maternal outcomes than normotensive women but have better outcomes than those with gestational hypertension and chronic hypertension [ 66 ]. Therefore, if OBP is elevated in untreated pregnant women, it may be useful to confirm the diagnosis of hypertension using ABPM or HBPM to avoid unnecessary treatment [ 67 , 68 ]. Consequently, women with WCH require continued HBPM throughout pregnancy to assess the risk of developing preeclampsia, having a small-for-gestational-age baby, and experiencing preterm birth.…”

“…Consequently, women with WCH require continued HBPM throughout pregnancy to assess the risk of developing preeclampsia, having a small-for-gestational-age baby, and experiencing preterm birth. In treated pregnant women, WUCH may be interpreted as uncontrolled hypertension or a hypertensive emergency, potentially leading to overtreatment or unnecessary interruption of pregnancy [ 68 ]. Therefore, ABPM or HBPM is required for the proper management of all pregnant women, regardless of gestational age.…”