Can 24‐hour ambulatory blood pressure measurement predict the development of hypertension in primigravidae?

Abstract

Objective To assess the role of 24-hour ambulatory blood pressure measurement in the mid-second Design Prospective intervention. Setting The Rotunda Hospital, Dublin. Participants One thousand one hundred and two healthy primigravid women, Intervention 24-hour ambulatory blood pressure measurement at 18 to 24 weeks of gestation. Main outcome measures The development of pre-eclampsia or gestational hypertension. Results A total of 1048 women had sufficient readings to be included in the final analysis. Of these, 23 (2.2%) developed pre-eclampsia, 64 (6.1%) developed gestational hypertension and 96 1 (91.7%) remained normotensive. Significantly higher ambulatory blood pressures were recorded in both the pre-eclamptic and gestational hypertensive group compared with the normotensive group. In addition, the gestational hypertensive group had significantly higher clinically measured blood pressure compared with the normotensive group. There were no differences between the preeclamptic and the gestational hypertensive group for any of the blood pressure parameters analysed. The best overall predictor for pre-eclampsia was 24-hour mean diastolic pressure which using a cutoff level of 71 mmHg gave a test with a sensitivity of only 22% and a positive predictive value of 15%.Conclusion Because the absolute differences are small and the overlap between the hypertensive and normotensive groups large, ambulatory blood pressure measurement, in a healthy primigravid population, between 18 and 24 weeks of gestation is not a useful predictor of hypertension.trimester as a predictive test for the development of hypertension in pregnancy.

Urinary albumin excretion and 24-hour blood pressure as predictors of pre-eclampsia in Type I diabetes

“…The best predictor for pre-eclampsia remained microalbuminuria before pregnancy with no additive effect of 24-h BP measurement. This is in accordance with the findings in healthy primigravid women where 24-h BP measurement between 18 and 24 weeks of gestation could not predict development of hypertension [8]. In early pregnancy the nocturnal decline in BP in our study was similar in women developing pre-eclampsia and women remaining normotensive.…”

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

“…While all these studies are based on ABPM done for 24 hours only, the most extended conclusion so far is that due to poor results in the diagnostic test based on the BP mean, ABPM does not provide a proper approach for the early identification of preeclampsia, and it should not be used in pregnancy. 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.…”

“…In the general practice, definitions of "normal" ABPM, 18 criteria for diagnosis of hypertension, 19,20 and assessment of antihypertensive therapy 21,22 have been established on the basis of mean values determined from data gathered every 15 to 30 minutes over a single 24-hour span, a sampling scheme also used in most studies on pregnant women. 8,9,11,14 Sampling requirements for the use of ABPM in the diagnosis of hypertension, however, have not yet been carefully taken into consideration. Along these lines, some advantages of 48-hour sampling instead of the most common 24-hour monitoring span in terms of reproducibility of results have been previously documented.…”

“…9 -11 Poor results from the diagnostic test based on mean BP values have led many authors to extrapolate erroneously that ABPM is not a valid approach in pregnancy. 11 Most studies conducted so far have been performed with ABPM for 24 hours. In the general practice, definitions of "normal" ABPM, 18 criteria for diagnosis of hypertension, 19,20 and assessment of antihypertensive therapy 21,22 have been established on the basis of mean values determined from data gathered every 15 to 30 minutes over a single 24-hour span, a sampling scheme also used in most studies on pregnant women.…”

Within-subject variability of differences between conventional and automated blood pressure measurements in pregnancy

“…Several ambulatory blood pressure devices have studies relating the office antenatal mercury blood pressure been validated against standard mercury to pregnancy outcome [13,14]. Except for one recently published study which tried to assess the role of mid-development of hypertension in pregnancy [15], there are validation procedure was performed every two hours no studies of appropriate size which relate ambulatory during a 24 h recording with the SpaceLabs monitor at 9, blood pressure behaviour to morbidity. Therefore, com-11, 13, 15, 17, 19, 21 and 23 h on the first day and at 9 h parison of the ambulatory device against mercury on the second day just before the 24 h measurement was sphygmomanometry -the accepted clinical gold standard ended.…”