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Ambulatory Blood Pressure Monitoring in Special Populations: During Pregnancy

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Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics

Part of the book series: Clinical Hypertension and Vascular Diseases ((CHVD))

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Abstract

Gestational hypertension (GH) and preeclampsia (PE) are major causes of perinatal morbidity and mortality. The diagnosis of these conditions still relies on unreliable conventional clinic blood pressure (BP) measurements and inappropriate thresholds of ≥140/90 mmHg for systolic/diastolic BP. Noninvasive around-the-clock ambulatory BP monitoring (ABPM) investigations have documented predictable differences in the 24-h BP pattern between pregnant women who during the course of gestation will remain normotensive versus those who will develop GH or PE. In normotensive pregnancies, ambulatory BP steadily decreases until the middle of gestation and thereafter increases slightly until delivery. In contrast, women who will develop GH or PE exhibit stable BP during the first half of pregnancy and afterwards a continuous linear and significantly greater BP increase until delivery. An additional typically neglected factors, but of nonetheless of great clinical significance for making the diagnosis of GH and PE, is the reported sex difference in the 24-h BP pattern. The lower BP of nongravid women compared to men plus the second trimester decrease of BP in normotensive pregnancies have yet to be taken into consideration when establishing BP reference thresholds for the diagnosis of GH and PE. Prospective studies designed to take all these factors into consideration have consistently documented that ABPM during gestation, commencing preferably at the time of the first obstetric examination following positive confirmation of pregnancy, provides (1) sensitive and specific endpoints for early identification of PE and other complications in pregnancy, and (2) guidance of very low-cost and highly effective prophylactic and/or therapeutic intervention. Accordingly, ABPM is now recommended as the gold standard, thereby replacing unreliable clinic BP measurements, for the diagnosis of hypertension in pregnancy and the screening of pregnant women at high risk for other complications of gestation.

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  1. Bioengineering and Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, Vigo (Pontevedra), 36310, Spain

    Ramón C. Hermida Ph.D. & Diana E. Ayala M.D., M.P.H., Ph.D.

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  1. Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA

    William B. White

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Hermida, R.C., Ayala, D.E. (2016). Ambulatory Blood Pressure Monitoring in Special Populations: During Pregnancy. In: White, W. (eds) Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics. Clinical Hypertension and Vascular Diseases. Humana Press, Cham. https://doi.org/10.1007/978-3-319-22771-9_13

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