Visit-to-visit blood pressure variability is associated with gestational hypertension and pre-eclampsia

Liu, Jieyu; Cao, Yingying; Gong, Tao; Wang, Jiaxiang; Jiawen, Lu; Yingjie, Gu; Qingzhou, Yu; Teng, Haoyue; Yin, Jieyun; Pan, Chen‐Wei

doi:10.1016/j.preghy.2019.09.009

Cited by 15 publications

(30 citation statements)

References 30 publications

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“…Among unselected pregnancies in China (N=14 702), long-term visit-to-visit BP variability (by SD and coefficient of variation and adjusted for BP level and important covariates) was predictive of gestational hypertension and preeclampsia 22 ; systolic variability was most strongly related to development of hypertension, in contrast to systolic and diastolic variability that were predictive among CLIP participants in South Asia and sub-Saharan Africa. Other pregnancy outcomes were not reported, and the impact not presented of excluding almost half of women with fewer than 3 visits in each of the second and third trimesters.…”

Section: Discussionmentioning

confidence: 97%

Pregnancy Outcomes and Blood Pressure Visit-to-Visit Variability and Level in Three Less-Developed Countries

Magee

Bone²,

Owasil

et al. 2021

Hypertension

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In pregnancy in well-resourced settings, limited data suggest that higher blood pressure (BP) visit-to-visit variability may be associated with adverse pregnancy outcomes. Included were pregnant women in 22 intervention clusters of the CLIP (Community-Level Interventions for Preeclampsia) cluster randomized trials, who had received at least 2 prenatal contacts from a community health worker, including standardized BP measurement. Mixed-effects adjusted logistic regression assessed relationships between pregnancy outcomes and both BP level (median [interquartile range]) and visit-to-visit variability (SD and average real variability [ARV], adjusted for BP level), among all women and those who became hypertensive. The primary outcome was the CLIP composite of maternal and perinatal mortality and morbidity. Among 17 770 pregnancies, higher systolic and diastolic BP levels were associated with increased odds of the composite outcome per 5 mm Hg increase in BP (odds ratio [OR], 1.05 [95% CI, 1.03–1.07] and OR, 1.08 [1.06–1.11], respectively). Higher BP visit-to-visit variability was associated with increased odds, per a SD increase in BP variability measure, of (1) hypertension (systolic: OR, 2.09 [1.98–2.21] for SD and 1.52 [1.45–1.60] for ARV; diastolic: OR, 2.70 [2.54–2.87] for SD and 1.86 [1.76–1.96] for ARV); and (2) the composite outcome (systolic: OR, 1.10 [1.06–1.14] for SD and 1.06 [1.02–1.10] for ARV; diastolic: OR, 1.07 [1.03–1.11] for SD and 1.06 [1.02–1.09] for ARV). In 3 less-developed countries, higher BP level and visit-to-visit variability predicted adverse pregnancy outcomes, providing an opportunity for high-definition medicine.

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Section: Discussionmentioning

confidence: 97%

Pregnancy Outcomes and Blood Pressure Visit-to-Visit Variability and Level in Three Less-Developed Countries

Magee

Bone²,

Owasil

et al. 2021

Hypertension

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show abstract

“…Our findings showed that indices of short- and long-term of BP variability gradually increased from controls, across women with preeclampsia, to those with gestational hypertension. Large study that included almost 1000 patients with gestational hypertension and preeclampsia investigated visit-to-visit BP variability in second and third trimester and reported similar results with significantly higher BP variability among women with gestational hypertension and preeclampsia than in normotensive controls [ 12 ]. In maximally adjusted models, authors showed that visit-to-visit BP variability was associated with gestational hypertension and preeclampsia [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Large study that included almost 1000 patients with gestational hypertension and preeclampsia investigated visit-to-visit BP variability in second and third trimester and reported similar results with significantly higher BP variability among women with gestational hypertension and preeclampsia than in normotensive controls [ 12 ]. In maximally adjusted models, authors showed that visit-to-visit BP variability was associated with gestational hypertension and preeclampsia [ 12 ]. The novelty of our study is inclusion of short-term BP variability and conclusion that short- and long-term BP variability assessments could be interchangeably used in clinical practice for all women with hypertensive disorders in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…The effect of blood pressure (BP) variability in pregnancy is also uncertain. Data are scarce and mainly based on mid- and long-term BP variability that was based on office BP measurements, which were made during each clinical visit—visit-to-visit variability [ 12 , 13 ]. Studies showed that visit-to-visit BP variability was associated with gestational hypertension and preeclampsia [ 12 ], as well as with risk of adverse birth outcomes in pregnant women without proteinuria or chronic hypertension [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Data are scarce and mainly based on mid- and long-term BP variability that was based on office BP measurements, which were made during each clinical visit—visit-to-visit variability [ 12 , 13 ]. Studies showed that visit-to-visit BP variability was associated with gestational hypertension and preeclampsia [ 12 ], as well as with risk of adverse birth outcomes in pregnant women without proteinuria or chronic hypertension [ 13 ]. Recent investigation reported that short-term BP variability obtained by 24-h ambulatory BP monitoring correlated with subclinical echocardiographic changes and microalbuminuria in normotensive women with history of preeclampsia or eclampsia [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Blood pressure variability correlates with right ventricular strain in women with gestational hypertension and preeclampsia

et al. 2021

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The aim of this study was to evaluate the short- and long-term blood pressure (BP) variability and right ventricular (RV) remodeling in women with gestational hypertension and preeclampsia, as well as their association. This cross-sectional study included 161 pregnant women (56 normotensive controls, 55 patients with gestational hypertension, and 50 patients with preeclampsia) after 20 weeks of gestation. All women underwent 24-h ambulatory BP monitoring and echocardiographic examination. Our findings showed that 24-h, daytime and nighttime systolic and diastolic BPs, as well as visit-to-visit systolic and diastolic BPs, were significantly higher in women with gestational hypertension and preeclampsia than in control group. Parameters of short- and long-term BP variability gradually increased from controls, throughout women with preeclampsia, to those with gestational hypertension. RV diameter, E/e′ and PAP were significantly higher in women with gestational hypertension and preeclampsia than in controls. Global and free wall RV longitudinal strains, as well as corresponding endo- and epicardial strains, gradually reduced from controls to women with preeclampsia. Parameters of short- and long-term BP variability were independently associated with global and free wall RV longitudinal strain. In conclusion, short- and long-term BP variability was higher in women with pregnancy-induced hypertensive disorders. RV diastolic function and mechanics were deteriorated in these women comparing with controls. A significant association between BP variability and RV longitudinal strain underlines the importance of determination of short- and long-term BP variability during pregnancy.

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Cardioautonomic control in pregnant individuals with advanced maternal age

Gervais,

Cooke,

Davidge

et al. 2023

Clin Auton Res

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Visit-to-visit blood pressure variability is associated with gestational hypertension and pre-eclampsia

Cited by 15 publications

References 30 publications

Pregnancy Outcomes and Blood Pressure Visit-to-Visit Variability and Level in Three Less-Developed Countries

Pregnancy Outcomes and Blood Pressure Visit-to-Visit Variability and Level in Three Less-Developed Countries

Blood pressure variability correlates with right ventricular strain in women with gestational hypertension and preeclampsia

Cardioautonomic control in pregnant individuals with advanced maternal age

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