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Thomopoulos C, Hitij JB, De Backer T, Gkaliagkousi E, Kreutz R, Lopez-Sublet M, Marketou M, Mihailidou AS, Olszanecka A, Pechère-Bertschi A, Pérez MP, Persu A, Piani F, Socrates T, Stolarz-Skrzypek K, Cífková R. Management of hypertensive disorders in pregnancy: a Position Statement of the European Society of Hypertension Working Group 'Hypertension in Women'. J Hypertens 2024; 42:1109-1132. [PMID: 38690949 DOI: 10.1097/hjh.0000000000003739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Hypertensive disorders in pregnancy (HDP), remain the leading cause of adverse maternal, fetal, and neonatal outcomes. Epidemiological factors, comorbidities, assisted reproduction techniques, placental disorders, and genetic predisposition determine the burden of the disease. The pathophysiological substrate and the clinical presentation of HDP are multifarious. The latter and the lack of well designed clinical trials in the field explain the absence of consensus on disease management among relevant international societies. Thus, the usual clinical management of HDP is largely empirical. The current position statement of the Working Group 'Hypertension in Women' of the European Society of Hypertension (ESH) aims to employ the current evidence for the management of HDP, discuss the recommendations made in the 2023 ESH guidelines for the management of hypertension, and shed light on controversial issues in the field to stimulate future research.
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Affiliation(s)
- Costas Thomopoulos
- Department of Cardiology, General Hospital of Athens 'Laiko', Athens, Greece
| | - Jana Brguljan Hitij
- Department of Hypertension, University Medical Centre Ljubljana, Medical University Ljubljana, Slovenia
| | - Tine De Backer
- Cardiovascular Center & Clinical Pharmacology, University Hospital Gent, Belgium
| | - Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Papageorgiou Hospital Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Reinhold Kreutz
- Charite-Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Marilucy Lopez-Sublet
- AP-HP, Hopital Avicenne, Centre d'Excellence Europeen en Hypertension Arterielle, Service de Medecine Interne, INSERM UMR 942 MASCOT, Paris 13-Universite Paris Nord, Bobigny, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists)
| | - Maria Marketou
- School of Medicine, University of Crete, Heraklion, Greece
| | - Anastasia S Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Agnieszka Olszanecka
- 1st Department of Cardiology, Interventional Electrocardiology, and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | | | - Mariana Paula Pérez
- Department of Hypertension. Hospital de Agudos J. M. Ramos Mejía, Buenos Aires, Argentina
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Federica Piani
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Thenral Socrates
- Medical Outpatient and Hypertension Clinic, ESH Hypertension Centre of Excellence University Hospital Basel, Basel, Switzerland
| | - Katarzyna Stolarz-Skrzypek
- 1st Department of Cardiology, Interventional Electrocardiology, and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Renata Cífková
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer University Hospital
- Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
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Mogos MF, Ahn S, Park C, LaNoue M, Osmundson S, Muchira JM. Twenty-Four-Hour Ambulatory Blood Pressure Monitoring Parameters During Pregnancy: A Pilot Study. J Womens Health (Larchmt) 2024; 33:788-797. [PMID: 38624221 DOI: 10.1089/jwh.2023.0921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
Introduction: Maternal blood pressure (BP) is a critical cardiovascular marker with profound implications for maternal and fetal well-being, particularly in the detection of hypertensive disorders during pregnancy. Although conventional clinic-based BP (CBP) measurements have traditionvally been used, monitoring 24-hour ambulatory BP (ABP) has emerged as a more reliable method for assessing BP levels and diagnosing conditions such as gestational hypertension and preeclampsia/eclampsia. This study aimed to assess the feasibility and acceptability of 24-hour ABP monitoring in pregnant women and report on various ABP parameters, including ambulatory blood pressure variability (ABPV). Method: A prospective cross-sectional study design was employed, involving 55 multipara pregnant women with and without prior adverse pregnancy outcomes (APOs). The participants underwent baseline assessments, including anthropometrics, resting CBP measurements, and the placement of ABP and actigraphy devices. Following a 24-hour period with these devices, participants shared their experiences to gauge device acceptability. Pregnancy outcomes were collected postpartum. Results: Twenty-four-hour ABP monitoring before 20 weeks of gestation is feasible for women with and without prior APOs. Although some inconvenience was noted, the majority of participants wore the ABP monitoring device for the entire 24-hour period. Pregnant women who later experienced APOs exhibited higher 24-hour ABP and ABPV values in the early stages of pregnancy. Conclusion: The study highlights the potential benefits of 24-hour ABP monitoring as a valuable tool in prenatal care, emphasizing the need for further research in this area.
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Affiliation(s)
- Mulubrhan F Mogos
- Center for Research Development and Scholarship, School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Soojung Ahn
- Center for Research Development and Scholarship, School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Chorong Park
- Center for Research Development and Scholarship, School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Marianna LaNoue
- Center for Research Development and Scholarship, School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Sarah Osmundson
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James M Muchira
- Center for Research Development and Scholarship, School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
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Left atrial structure and function: association with blood pressure variability in pregnant women. Blood Press Monit 2023; 28:42-46. [PMID: 36606478 DOI: 10.1097/mbp.0000000000000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The aim of this study was to investigate the relationship between left atrial (LA) abnormalities and ambulatory blood pressure variability (BPV) in pregnant women and their relationship with hypertension-related clinical outcomes in pregnancy. METHODS This single-center, prospective study included 119 pregnant women. All participants underwent 24-h ambulatory blood pressure (BP) monitoring and echocardiographic examination before 20 weeks of gestation. BPV was evaluated using 24-h ambulatory BP monitoring. SD of the mean of SBP (SBP-SD) and DBP variability was calculated as 24-h, daytime and nighttime SBP and DBP. The patients were classified into two groups based on median 24-h SBP-SD (11.3 mmHg). LA features of the patients were compared according to the high and low BPV groups. RESULTS One hundred and nineteen pregnant women (mean age, 28.6 ± 5.2 years) were included in the study. The mean office SBP and DBP were 108.7 ± 15.4 mmHg and 68.2 ± 10.2 mmHg, respectively. In pregnant women with high BPV, even though BP is normal, reservoir and conduit LA functions have decreased and LA stiffness has increased. Gestational hypertension and composite outcomes were more common in pregnant women with high BPV. Among the LA parameters, the most associated with composite outcome was conduit LA function. CONCLUSION In pregnancy, higher BPV is associated with worse LA function. The LA conduit strain offers potential value in predicting hypertension-related clinical outcomes in pregnancy.
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Deshpande SS, Gadappa SN, Badgire SA, Sholapure AS, Kamble MS, Baxy HS. Study of Feasibility of Blood Pressure Monitoring in Postpartum Women by Teleconsultation in COVID 19 Pandemic Situation. J Obstet Gynaecol India 2022; 72:186-191. [PMID: 35340907 PMCID: PMC8938646 DOI: 10.1007/s13224-021-01580-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose of the Study To study the feasibility of blood pressure monitoring and to assess the feasibility of antihypertensive dose adjustment in postpartum women by teleconsultation in COVID 19 pandemic situation. Methods This was a descriptive longitudinal study conducted in the Department of OBGY, GMCH, Aurangabad between the study periods November 2020 to April 2021 with a sample size of 60. The feasibility of blood pressure monitoring in postpartum women by teleconsultation was measured by recruitment and retention through 12 weeks postpartum. The feasibility of anti-hypertensive dose adjustment through teleconsultation was measured by the number of women requiring hospital visit for uncontrolled blood pressure or those with warning signs and symptoms. The data were collected and analyzed. Results The feasibility of blood pressure monitoring in postpartum women by teleconsultation was 95.23%. During follow-up, the antihypertensive drug dose was required to be increased in 3 women. Not a single woman required hospital visit or hospital readmission either due to uncontrolled hypertension or warning signs/symptoms. This indicates that the feasibility of anti-hypertensive dose adjustment by teleconsultation was good. Conclusion We demonstrated feasibility and over all good satisfaction rate of Blood Pressure Monitoring in postpartum women by teleconsultation in COVID 19 pandemic situation and found that teleconsultation is a boon in management for postpartum hypertension to reduce readmissions and decrease maternal morbidity while ensuring social distancing and minimizing viral exposure. We recommend teleconsultation as a quality improvement initiative in maternity care.
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Affiliation(s)
- Sonali S Deshpande
- Department of Obstetrics and Gynecology, Government Medical College and Hospital, Aurangabad, Maharashtra 431001 India
| | - Shrinivas N Gadappa
- Department of Obstetrics and Gynecology, Government Medical College and Hospital, Aurangabad, Maharashtra 431001 India
| | - Swati A Badgire
- Department of Obstetrics and Gynecology, Government Medical College and Hospital, Aurangabad, Maharashtra 431001 India
| | - Apurva S Sholapure
- Department of Obstetrics and Gynecology, Government Medical College and Hospital, Aurangabad, Maharashtra 431001 India
| | - Mayura S Kamble
- Department of Obstetrics and Gynecology, Government Medical College and Hospital, Aurangabad, Maharashtra 431001 India
| | - Himani S Baxy
- Department of Obstetrics and Gynecology, Government Medical College and Hospital, Aurangabad, Maharashtra 431001 India
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Blood Pressure Monitoring and Perinatal Outcomes in Normotensive Women with Gestational Diabetes Mellitus. J Clin Med 2022; 11:jcm11051435. [PMID: 35268526 PMCID: PMC8911501 DOI: 10.3390/jcm11051435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/25/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022] Open
Abstract
Alterations in ambulatory blood pressure detected by monitoring (ABPM) have been associated with perinatal complications in hypertensive pregnant women. Aim: To establish the relationships between the blood pressure (BP) profiles detected by ABPM and adverse perinatal outcomes in normotensive women with gestational diabetes mellitus (GDM). Methods: A prospective study of normotensive women in whom 24 h ABPM was performed at 28–32 weeks of pregnancy. The obstetric and perinatal outcomes were evaluated. Results: Two hundred patients were included. Thirty-seven women with GDM and obesity had significantly higher mean systolic BP (SBP) and nocturnal SBP and diastolic BP (DBP) compared to women with only GDM (n = 86). Nocturnal SBP (OR = 1.077; p = 0.015) and obesity (OR = 1.131; p = 0.035) were risk factors for the development of hypertensive disorders of pregnancy (HDPs). Mothers of newborns with neonatal complications (n = 27) had higher nocturnal SBP (103.8 vs. 100 mmHg; p = 0.047) and DBP (62.7 vs. 59.4; p = 0.016). Women who delivered preterm (n = 10) had higher BP and a non-dipper pattern (p = 0.005). Conclusions: Nocturnal SBP was a predictor of HDPs in normotensive women with obesity or GDM. Alterations in ABPM in these patients were associated with poor obstetric and perinatal outcomes.
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Aquino M, Griffith J, Vattaparambil T, Munce S, Hladunewich M, Seto E. Patients' and Providers' Perspectives on and Needs of Telemonitoring to Support Clinical Management and Self-care of People at High Risk for Preeclampsia: Qualitative Study. JMIR Hum Factors 2022; 9:e32545. [PMID: 35129445 PMCID: PMC8861860 DOI: 10.2196/32545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/24/2021] [Accepted: 11/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background Preeclampsia is one of the leading causes of maternal mortality worldwide, with a global prevalence at 2%-8% of pregnancies. Patients at high risk for preeclampsia (PHRPE) have an increased risk of complications, such as fetal growth restriction, preterm delivery, abnormal clotting, and liver and kidney disease. Telemonitoring for PHRPE may allow for timelier diagnosis and enhanced management, which may improve maternal and perinatal outcomes. Objective The objective of this study is to determine the perceptions and needs of PHRPE and their health care providers with respect to telemonitoring through semistructured interviews with both groups. This study explored (1) what the needs and challenges of monitoring PHRPE are during pregnancy and in the postpartum period and (2) what features are required in a telemonitoring program to support self-care and clinical management of PHRPE. Methods This study used a qualitative descriptive approach, and thematic analysis was conducted. PHRPE and health care providers from a high-risk obstetrical clinic in a large academic hospital in Toronto, Canada, were asked to participate in individual semistructured interviews. Two researchers jointly developed a coding framework and separately coded each interview to ensure that the interviews were double-coded. The software program NVivo version 12 was used to help organize the codes. Results In total, 7 PHRPE and 5 health care providers, which included a nurse practitioner and physicians, participated in the semistructured interviews. Using thematic analysis, perceptions on the benefits, barriers, and desired features were determined. Perceived benefits of telemonitoring for PHRPE included close monitoring of home blood pressure (BP) measurements and appropriate interventions for abnormal BP readings; the development of a tailored telemonitoring system for pregnant patients; and facilitation of self-management. Perceived barriers to telemonitoring for PHRPE included financial and personal barriers, as well as the potential for increased clinician workload. Desired features of a secure platform for PHRPE included the facilitation of self-management for patients and decision making for clinicians, as well as the inclusion of evidence-based action prompts. Conclusions The perceptions of patients and providers on the use of telemonitoring for PHRPE support the need for a telemonitoring program for the management of PHRPE. Recommendations from this study include the specific features of a telemonitoring program for PHRPE, as well as the use of frameworks and design processes in the design and implementation of a telemonitoring program for PHRPE.
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Affiliation(s)
- Maria Aquino
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Janessa Griffith
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Tessy Vattaparambil
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Sarah Munce
- Department of Occupational Sciences and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Michelle Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
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Thomas NA, Drewry A, Racine Passmore S, Assad N, Hoppe KK. Patient perceptions, opinions and satisfaction of telehealth with remote blood pressure monitoring postpartum. BMC Pregnancy Childbirth 2021; 21:153. [PMID: 33607957 PMCID: PMC7896378 DOI: 10.1186/s12884-021-03632-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background Our aim was to conduct a post participation survey of respondent experiences with in-home remote patient monitoring via telehealth for blood pressure monitoring of women with postpartum hypertension. We hypothesized that the in-home remote patient monitoring application will be implemented with strong fidelity and have positive patient acceptability. Methods This analysis was a planned secondary analysis of a non-randomized controlled trial of telehealth with remote blood pressure patient monitoring for postpartum hypertension compared to standard outpatient monitoring in women with a hypertension-related diagnosis during pregnancy. In collaboration with survey experts, we developed a 41-item web-based survey to assess 1) perception of quality of care received, 2) ease of use/ease to learn the telehealth program, 3) effective orientation of equipment, 4) level of perceived security/privacy utilizing telehealth and 5) problems encountered. The survey included multiple question formats including Likert scale responses, dichotomous Yes/No responses, and free text. We performed a descriptive analysis on all responses and then performed regression analysis on a subset of questions most relevant to the domains of interest. The qualitative data collected through open ended responses was analyzed to determine relevant categories. Intervention participants who completed the study received the survey at the 6-week study endpoint. Results Sixty six percent of respondents completed the survey. The majority of women found the technology fit easily into their lifestyle. Privacy concerns were minimal and factors that influenced this included age, BMI, marital status, and readmissions. 95% of women preferred remote care for postpartum follow-up, in which hypertensive type, medication use and ethnicity were found to be significant factors in influencing location of follow-up. Most women were satisfied with the devices, but rates varied by hypertensive type, infant discharge rates and BMI. Conclusions Postpartum women perceived the telehealth remote intervention was a safe, easy to use method that represented an acceptable burden of care and an overall satisfying method for postpartum blood pressure monitoring. Trial registration ClinicalTrials.gov identification number: NCT03111095 Date of registration: April 12, 2017.
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Affiliation(s)
- Nicole A Thomas
- University of Wisconsin-Madison, School of Nursing, Signe Skott Cooper Hall, 701 Highland Avenue, Madison, WI, 53705, USA.
| | - Anna Drewry
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Susan Racine Passmore
- University of Wisconsin-Madison, Collaborative Center for Health Equity, School of Medicine and Public Health, Madison, WI, USA
| | - Nadia Assad
- University of Wisconsin-Madison Survey Center, Madison, WI, USA
| | - Kara K Hoppe
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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Zhong L, Deng W, Zheng W, Yu S, Huang X, Wen Y, Chiu PCN, Lee CL. The relationship between circadian blood pressure variability and maternal/perinatal outcomes in women with preeclampsia with severe features. Hypertens Pregnancy 2020; 39:405-410. [PMID: 32744911 DOI: 10.1080/10641955.2020.1797777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether circadian blood pressure (BP) variation of women with preeclampsia (PE) with severe features was associated with adverse maternal/perinatal outcomes. METHODS 173 women with PE with severe features were recruitedand categorized into three groups: dipper, non-dipper and reverse dipper type BP group.. Maternal and perinatal outcomes were compared among groups. RESULTS There were significant differences in gestational ages, premature delivery, retinopathy, HELLP syndrome, mean birth weight, rate of low birth weight infants and fetal growth restriction. CONCLUSION Aberrant circadian pattern of BP in women with PE with severe features was associated with several adverse maternal/perinatal outcomes.
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Affiliation(s)
- Liuying Zhong
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Wenfeng Deng
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Weihan Zheng
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Shuting Yu
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Xiaosi Huang
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Yaohong Wen
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Philip C N Chiu
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong , Hong Kong
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital , Guangdong, P.R. China
| | - Cheuk-Lun Lee
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong , Hong Kong
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital , Guangdong, P.R. China
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What happened after birth to pregnant women undergoing ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension? J Hum Hypertens 2020; 34:814-817. [PMID: 33005015 DOI: 10.1038/s41371-020-00418-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/29/2020] [Accepted: 09/15/2020] [Indexed: 11/08/2022]
Abstract
The latest Brazilian Guidelines on ambulatory blood pressure monitoring (ABPM) consider an exam as a useful tool during pregnancy, especially during the first half of pregnancy. They also indicate that white coat hypertension as well as masked hypertension may occur in up to one-third of pregnancies. As white coat hypertension has a more favorable diagnosis than gestational hypertension, it remains associated with 50% of pregnancies and is not associated with complications. Elsewhere, 40% of pregnant women develop gestational hypertension. As per the guidelines, the guidance values should be the same for the general population. The aim of this study was to verify the blood pressure behavior after birth in pregnant women who underwent ABPM and whether ABPM in pregnant women may serve as a predictor of preeclampsia and abnormalities in newborns. Between 01 January 2017 and 31 December 2019, 117 ABPM routines in pregnant women were performed at Unicordis. Among them, 40 were requested for the diagnosis of hypertension, and 77 were requested for antihypertensive therapeutic assessment. The study population comprised pregnant women who underwent ABPM for the diagnosis of hypertension. We assessed a population that comprised 31 subjects who underwent ABPM, 17 of whom had normal results and 14 of whom had abnormal results. Of the 14 pregnant women with abnormal blood pressure behavior, only three (21%) had a physiological drop in blood pressure, seven had attenuated descent, and four did not have blood arterial descent. The age of the pregnant women ranged from 21 to 42 years. The gestational age at the beginning of ABPM ranged from 6 to 37 weeks. In the group with normal ABPM, two pregnant women (11.7%) developed preeclampsia during pregnancy. Additionally, in the group with abnormal ABPM, seven pregnant women (50%) developed preeclampsia during pregnancy. In the group with normal ABPM, three newborns had abnormalities (17.6%); in the group with abnormal ABPM, four newborns had abnormalities (28.5%). In the group with normal ABPM, two subjects developed hypertension after birth (11.7%). In the group with abnormal ABPM, ten subjects (71%) remained hypertensive following birth (Table 1). Conclusions: (1) the results show that the proportion of patients who presented with preeclampsia was higher among individuals with abnormal ABPM than that among individuals with normal ABPM. (2) The proportion of subjects with hypertension following birth was higher among individuals with abnormal ABPM than that among individuals with normal ABPM.
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Abstract
OBJECTIVE This study aimed to study the association between maternal history of childhood adversity and blood pressure in pregnancy. METHODS A total of 127 pregnant women completed measures of adverse childhood experiences (ACE) and prenatal stress between June 2015 and April 2019. At 11 weeks' gestation (range, 6-17 weeks), we measured 24-hour ambulatory blood pressure. All women were considered to be at risk for pregnancy complications due to elevated body mass index and self-reporting snoring in pregnancy. RESULTS Women were, on average, 30 years old (range, 19-40 years), and average (standard deviation) body mass index in this sample was 34 (7) kg/m (range, 27-55 kg/m). Higher ACE scores were associated with higher nighttime blood pressure (systolic blood pressure: β = 0.23, p = .013; diastolic blood pressure: β = 0.22, p = .028). There were no significant associations between the ACE score and daytime blood pressure. Women with four or more ACEs were more likely to display nocturnal blood pressure nondipping (odds ratio = 3.97, 95% confidence interval = 1.38-11.40). Associations between ACE and nocturnal blood pressure remained significant after adjusting for symptoms of prenatal stress. CONCLUSIONS Results indicate that experiences of childhood adversity are associated with elevated nocturnal blood pressure and loss of a typical decline in blood pressure between day and night.
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Cheu LA, Drexler K, Kominiarek MA. Using m-Health apps to diagnose hypertension in pregnancy. Pregnancy Hypertens 2020; 22:99-100. [PMID: 32769046 DOI: 10.1016/j.preghy.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/12/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Lindsay A Cheu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology of Northwestern University, 250 E. Superior, Suite 05-2149, Prentice Women's Hospital Chicago, IL 60611, United States.
| | - Kathleen Drexler
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology of Northwestern University, 250 E. Superior, Suite 05-2149, Prentice Women's Hospital Chicago, IL 60611, United States
| | - Michelle A Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology of Northwestern University, 250 E. Superior, Suite 05-2149, Prentice Women's Hospital Chicago, IL 60611, United States
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Hasan SMT, Ahmed SI, Khan MA, Sarker SA, Ahmed T. Achieving Optimal Gestational Weight Gain, Birth Weight, and Perinatal Outcomes Among Pregnant Women at Risk of Hypertension: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e16676. [PMID: 32459639 PMCID: PMC7324999 DOI: 10.2196/16676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background Hypertensive disorders, including preeclampsia, complicate 10% of all pregnancies, causing maternal and fetal morbidity and mortality. In Bangladesh, 24% of all maternal deaths are directly attributed to hypertensive disorders. Conventional antenatal care practices often delay or miss detecting hypertensive disorders in pregnancy, which may allow some women to become vulnerable to the adverse consequences of the hypertensive disorders. Regular self-monitoring of blood pressure and weight gain may improve maternal and fetal outcomes among pregnant women at risk of developing hypertensive disorders during pregnancy through early diagnosis, prompt referral, and timely clinical management; however, to undertake a randomized controlled trial of an intervention to reduce adverse consequences of hypertensive disorders in pregnancy, its feasibility must first be determined. Objective The objectives of this study are to evaluate the accuracy of a wearable blood pressure monitoring device (Health Gauge) in order to test the design and methods of a future definitive randomized controlled trial, and to examine the feasibility, acceptability, and fidelity of an intervention focusing on regular monitoring of weight gain and self-monitoring of blood pressure for pregnant women at risk of developing hypertensive disorders and their associated complications. Methods The study is located in Matlab, Bangladesh will be conducted in two phases. First, a wearable blood pressure device (Health Gauge) will be validated in accordance with the European Society of Hypertension International Protocol (revision 2010). Second, a prospective, two-arm, parallel, and nonblinded randomized controlled external pilot trial will be conducted. In the pilot trial, 70 eligible participants will be individually randomized to the intervention arm, in which pregnant women will self-monitor their blood pressure daily using a wearable device (Health Gauge) and be evaluated monthly by trained health workers for weight gain from 20 weeks of gestation until delivery, or the control arm, in which pregnant women will be assessed for weight gain every two months from 20 weeks of gestation until delivery (1:1 intervention to control allocation ratio using a permuted block randomization method with concealment). All women will receive standard antenatal care. Results A validation study of the wearable blood pressure device has successfully been conducted among the general adult population in Matlab, Bangladesh. As of September 2019, the pilot trial has completed enrollment of women who are pregnant (N=70; intervention: n=35; control: n=35) and follow-up of the participants is ongoing. Data analysis is expected to be completed by June 2020, and results are expected to be submitted for publication in August 2020. Conclusions The findings of this study will help us to design a comprehensive, full-scale randomized controlled trial to test the efficacy of regular self-monitoring of blood pressure and weight gain during pregnancy, a simple and inexpensive intervention to help to achieve optimal maternal and fetal outcomes in pregnant women at risk of developing hypertensive disorders and their associated complications during pregnancy. Trial Registration ClinicalTrials.gov NCT03858595; https://clinicaltrials.gov/ct2/show/NCT03858595 International Registered Report Identifier (IRRID) DERR1-10.2196/16676
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Affiliation(s)
- S M Tafsir Hasan
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Syed Imran Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Md Alfazal Khan
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
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Excessive umbilical cord coiling confers risk of elevated nocturnal blood pressure and severe/early-onset preeclampsia. J Hypertens 2020; 37:187-196. [PMID: 30015757 DOI: 10.1097/hjh.0000000000001849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The associations between umbilical cord coiling, feto-placental vascular resistance and maternal blood pressure (BP) are not well understood. METHOD We retrospectively analyzed 502 pregnant women suspected of hypertensive disorders in the third trimester from a hospital-based cohort, who underwent ambulatory BP monitoring and umbilical artery Doppler velocimetry examinations within 14 days before delivery. By applying quantile regression, a significant quantile-dependent positive association between umbilical cord coiling index and umbilical artery pulsatility index (UAPIMOM; converted to multiples of median) was observed from above 0.75th quantiles for each parameter. RESULTS Using the cutoffs both at the 0.75th quantile to define high umbilical cord coiling (≥0.28 coils/cm) and high UAPIMOM (≥1.30), respectively, a graded increase in BP level was observed from patients with both low, either high and both high categories. Multivariate linear and quantile regression revealed that the high umbilical cord coiling/high UAPIMOM interaction was significantly correlated with night-time mean DBP level. Moreover, umbilical cord hypercoiling (≥0.3 coils/cm) was significantly correlated with night-time DBP with an average increase of ∼5 mmHg from the 0.05th to 0.70th quantiles and independently predicted the occurrence of severe (odds ratio 2.32, 95% confidence interval: 1.22-4.41) and early-onset (odds ratio 2.43, 95% confidence interval: 1.18-4.97) preeclampsia after adjusting for covariates. Further mediation analysis showed that elevated high UAPIMOM (≥1.30) could explain 11.4% of the umbilical cord hypercoiling → high night-time DBP association. CONCLUSION Therefore, this retrospective study identifies excessive umbilical cord coiling, and its interaction with increased feto-placental vascular resistance, as novel risk factors for nocturnal BP elevation and preeclampsia.
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Abstract
ZusammenfassungErhöhter Blutdruck bleibt eine Hauptursache von kardiovaskulären Erkrankungen, Behinderung und frühzeitiger Sterblichkeit in Österreich, wobei die Raten an Diagnose, Behandlung und Kontrolle auch in rezenten Studien suboptimal sind. Das Management von Bluthochdruck ist eine häufige Herausforderung für Ärztinnen und Ärzte vieler Fachrichtungen. In einem Versuch, diagnostische und therapeutische Strategien zu standardisieren und letztendlich die Rate an gut kontrollierten Hypertoniker/innen zu erhöhen und dadurch kardiovaskuläre Erkrankungen zu verhindern, haben 13 österreichische medizinische Fachgesellschaften die vorhandene Evidenz zur Prävention, Diagnose, Abklärung, Therapie und Konsequenzen erhöhten Blutdrucks gesichtet. Das hier vorgestellte Ergebnis ist der erste Österreichische Blutdruckkonsens. Die Autoren und die beteiligten Fachgesellschaften sind davon überzeugt, daß es einer gemeinsamen nationalen Anstrengung bedarf, die Blutdruck-assoziierte Morbidität und Mortalität in unserem Land zu verringern.
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Preeclampsia: Risk Factors, Diagnosis, Management, and the Cardiovascular Impact on the Offspring. J Clin Med 2019; 8:jcm8101625. [PMID: 31590294 PMCID: PMC6832549 DOI: 10.3390/jcm8101625] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 09/22/2019] [Accepted: 10/02/2019] [Indexed: 12/20/2022] Open
Abstract
Hypertensive disorders of pregnancy affect up to 10% of pregnancies worldwide, which includes the 3%–5% of all pregnancies complicated by preeclampsia. Preeclampsia is defined as new onset hypertension after 20 weeks’ gestation with evidence of maternal organ or uteroplacental dysfunction or proteinuria. Despite its prevalence, the risk factors that have been identified lack accuracy in predicting its onset and preventative therapies only moderately reduce a woman’s risk of preeclampsia. Preeclampsia is a major cause of maternal morbidity and is associated with adverse foetal outcomes including intra-uterine growth restriction, preterm birth, placental abruption, foetal distress, and foetal death in utero. At present, national guidelines for foetal surveillance in preeclamptic pregnancies are inconsistent, due to a lack of evidence detailing the most appropriate assessment modalities as well as the timing and frequency at which assessments should be conducted. Current management of the foetus in preeclampsia involves timely delivery and prevention of adverse effects of prematurity with antenatal corticosteroids and/or magnesium sulphate depending on gestation. Alongside the risks to the foetus during pregnancy, there is also growing evidence that preeclampsia has long-term adverse effects on the offspring. In particular, preeclampsia has been associated with cardiovascular sequelae in the offspring including hypertension and altered vascular function.
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Pergialiotis V, Karampetsou N, Bellos I, Papantoniou N, Daskalakis G. Nocturnal blood pressure alterations in patients with preeclampsia – Do they really matter? A systematic review of the literature. Eur J Obstet Gynecol Reprod Biol 2019; 239:39-44. [DOI: 10.1016/j.ejogrb.2019.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 01/12/2023]
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Ambulatory Blood Pressure Monitoring in Pregnancy; Does It Influence Our Practice? Nephrourol Mon 2019. [DOI: 10.5812/numonthly.93157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Braunthal S, Brateanu A. Hypertension in pregnancy: Pathophysiology and treatment. SAGE Open Med 2019; 7:2050312119843700. [PMID: 31007914 PMCID: PMC6458675 DOI: 10.1177/2050312119843700] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/22/2019] [Indexed: 12/14/2022] Open
Abstract
Hypertensive disorders of pregnancy, an umbrella term that includes preexisting and gestational hypertension, preeclampsia, and eclampsia, complicate up to 10% of pregnancies and represent a significant cause of maternal and perinatal morbidity and mortality. Despite the differences in guidelines, there appears to be consensus that severe hypertension and non-severe hypertension with evidence of end-organ damage need to be controlled; yet the ideal target ranges below 160/110 mmHg remain a source of debate. This review outlines the definition, pathophysiology, goals of therapy, and treatment agents used in hypertensive disorders of pregnancy.
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Affiliation(s)
| | - Andrei Brateanu
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
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Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, Hall DR, Warren CE, Adoyi G, Ishaku S. Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice. Hypertension 2019; 72:24-43. [PMID: 29899139 DOI: 10.1161/hypertensionaha.117.10803] [Citation(s) in RCA: 1096] [Impact Index Per Article: 219.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mark A Brown
- From the Departments of Renal Medicine and Medicine, St. George Hospital and University of New South Wales, Sydney, Australia (M.A.B.)
| | - Laura A Magee
- Faculty of Life Sciences and Medicine, King's College London, United Kingdom (L.A.M.)
| | - Louise C Kenny
- Faculty of Health and Life Sciences, University of Liverpool, United Kingdom (L.C.K.).,INFANT Centre, Cork University Maternity Hospital, Ireland (L.C.K., F.P.M.)
| | - S Ananth Karumanchi
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (S.A.K.)
| | - Fergus P McCarthy
- INFANT Centre, Cork University Maternity Hospital, Ireland (L.C.K., F.P.M.)
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama, Japan (S.S.)
| | - David R Hall
- Department Obstetrics and Gynecology, Stellenbosch University and Tygerberg Hospital, South Africa (D.R.H.)
| | - Charlotte E Warren
- Reproductive Health Program, Population Council, Washington, DC (C.E.W.)
| | - Gloria Adoyi
- Reproductive Health Program, Population Council-Nigeria, West Africa (G.A., S.I.)
| | - Salisu Ishaku
- Reproductive Health Program, Population Council-Nigeria, West Africa (G.A., S.I.)
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Hoppe KK, Williams M, Thomas N, Zella JB, Drewry A, Kim K, Havighurst T, Johnson HM. Telehealth with remote blood pressure monitoring for postpartum hypertension: A prospective single-cohort feasibility study. Pregnancy Hypertens 2019; 15:171-176. [PMID: 30825917 PMCID: PMC6681910 DOI: 10.1016/j.preghy.2018.12.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/05/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Investigate feasibility of telehealth with remote blood pressure monitoring for management of hypertension in postpartum women at risk of severe hypertension after hospital discharge. METHODS In a single-center, prospective single-cohort feasibility study, women with hypertension in pregnancy participated in a postpartum telehealth intervention for blood pressure management after discharge. The primary feasibility outcome measures were recruitment and retention through 6 weeks postpartum. Secondary outcomes included the incidence of severe postpartum hypertension and/or need for blood pressure treatment after discharge, participant satisfaction, and 6-week hospital readmission. Participants received a tablet and equipment to transmit vital signs to a central monitoring site daily. Participants participated in telehealth or telephone visits with a nurse at 48 h and as needed. RESULTS Among 1413 deliveries 263 (19%) women had hypertension in pregnancy and 55/124 (47%) of women approached were consented. The retention rate was 95%. Among study participants, the incidence of severe hypertension after discharge was 9 (16%). 29 (53%) of participants required treatment due to exacerbations in blood pressure after discharge, in which 9(16%) were severe. There were no hospital readmissions. Overall 39 (86%) participants were satisfied with the remote monitoring. CONCLUSIONS Feasibility and participant satisfaction were demonstrated. The incidence of severe hypertension and need for blood pressure treatment after discharge and during 6 weeks postpartum was 16% and 53%. Our results indicate telehealth is a promising strategy for postpartum hypertension management to decrease maternal morbidity and hospital readmission.
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Affiliation(s)
- Kara K Hoppe
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States.
| | - Makeba Williams
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Nicole Thomas
- UnityPoint Health-Meriter, Madison, WI, United States
| | - Julia B Zella
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Anna Drewry
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, United States
| | - Thomas Havighurst
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, United States
| | - Heather M Johnson
- Division of Cardiovascular Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
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Dadlani A, Madan K, Sawhney JPS. Ambulatory blood pressure monitoring in clinical practice. Indian Heart J 2018; 71:91-97. [PMID: 31000190 PMCID: PMC6477132 DOI: 10.1016/j.ihj.2018.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 12/20/2022] Open
Abstract
Being one of the most widely prevalent diseases throughout the world, hypertension has emerged as one of the leading causes of global premature morbidity and mortality. Hence, blood pressure (BP) measurements are essential for physicians in the diagnosis and management of hypertension. Current American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend initiating antihypertensive medications on the basis of office BP readings. However, office BP readings provide a snapshot evaluation of the patient's BP, which might not reflect patient's true BP, with the possibility of being falsely elevated or falsely low. Recently, there is ample evidence to show that ambulatory blood pressure monitoring (ABPM) is a better predictor of major cardiovascular events than BP measurements at clinic settings. ABPM helps in reducing the number of possible false readings, along with the added benefit of understanding the dynamic variability of BP. This article will focus on the significance of ambulatory BP, its advantages and limitations compared with the standard office BP measurement and a brief outlook on its use and interpretation to diagnose and treat hypertension.
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Affiliation(s)
- Apaar Dadlani
- Division of Nephrology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA.
| | - Kushal Madan
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - J P S Sawhney
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
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Van Den Heuvel JFM, Lely AT, Franx A, Bekker MN. Validation of the iHealth Track and Omron HEM-9210T automated blood pressure devices for use in pregnancy. Pregnancy Hypertens 2018; 15:37-41. [PMID: 30825925 DOI: 10.1016/j.preghy.2018.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Self monitoring of blood pressure in pregnancy is increasingly popular with both health care professionals and patients. We assessed the validity of the iHealth Track and Omron HEM-9210T automated blood pressure devices (with Bluetooth connectivity) for the use in telemonitoring of blood pressure in pregnancy. METHODS In this prospective observational study, the revised 2010 International Protocol of the European Hypertension Society (EHS) was used for the validation of the two devices against auscultatory sphygmomanometry by two independent observers who took 13 same arm measurements in 33 pregnant women, of which 10 were diagnosed with preeclampsia. The measurements were alternated between the test device and a calibrated aneroid sphygmomanometer following the protocol. Both automated devices were assessed sequentially in the same women. RESULTS In the group of 33 women, the iHealth Track passed the EHS 2010 validation criteria with 86/98/99 of 99 device-observer systolic measurement comparisons and 88/96/98 of 99 device-observer diastolic measurement comparisons within the 5/10/15 mmHg boundaries respectively. The Omron HEM-9210T passed the same criteria with 85/94/99 of 99 device-observer systolic measurement comparisons and 82/95/99 of 99 device-observer diastolic measurement comparisons. CONCLUSIONS The iHealth Track and Omron HEM-9210T automated blood pressure monitors are validated for use in pregnancy. These two devices can now be added to the short list of validated devices in pregnancy and can be used for self-measurement of blood pressure in a telemonitoring setting of pregnant patients with (a high risk of) hypertensive disease.
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Affiliation(s)
- Josephus F M Van Den Heuvel
- Department of Obstetrics, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - A Titia Lely
- Department of Obstetrics, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Arie Franx
- Department of Obstetrics, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Consequences of in-utero exposure to antihypertensive medication: the search for definitive answers continues. J Hypertens 2018; 35:2161-2164. [PMID: 28953585 DOI: 10.1097/hjh.0000000000001486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Diagnosis of White Coat Hypertension and pregnancy outcomes. Pregnancy Hypertens 2018; 14:121-124. [DOI: 10.1016/j.preghy.2018.08.452] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/07/2018] [Accepted: 08/19/2018] [Indexed: 11/21/2022]
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Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, Hall DR, Warren CE, Adoyi G, Ishaku S. The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens 2018; 13:291-310. [DOI: 10.1016/j.preghy.2018.05.004] [Citation(s) in RCA: 470] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Perry H, Sheehan E, Thilaganathan B, Khalil A. Home blood-pressure monitoring in a hypertensive pregnant population. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:524-530. [PMID: 29468771 DOI: 10.1002/uog.19023] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/05/2018] [Accepted: 01/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The majority of patients with chronic or gestational hypertension do not develop pre-eclampsia. Home blood-pressure monitoring (HBPM) has the potential to offer a more accurate and acceptable means of monitoring hypertensive patients during pregnancy compared with traditional pathways of frequent outpatient monitoring. The aim of this study was to determine whether HBPM reduces visits to antenatal services and is safe in pregnancy. METHODS This was a case-control study of 166 hypertensive pregnant women, which took place at St George's Hospital, University of London. Inclusion criteria were: chronic hypertension, gestational hypertension or high risk of developing pre-eclampsia, no significant proteinuria (≤ 1+ proteinuria on dipstick testing) and normal biochemical and hematological markers. Exclusion criteria were maternal age < 16 years, systolic blood pressure > 155 mmHg or diastolic blood pressure > 100 mmHg, significant proteinuria (≥ 2+ proteinuria on dipstick testing or protein/creatinine ratio > 30 mg/mmol), evidence of small-for-gestational age (estimated fetal weight < 10th centile), signs of severe pre-eclampsia, significant mental health concerns or insufficient understanding of the English language. Pregnant women in the HBPM group were taught how to measure and record their blood pressure using a validated machine at home and attended every 1-2 weeks for assessment depending on clinical need. The control group was managed as per the local protocol prior to the implementation of HBPM. The two groups were compared with respect to number of visits to antenatal services and outcome. RESULTS There were 108 women in the HBPM group and 58 in the control group. There was no difference in maternal age, parity, body mass index, ethnicity or smoking status between the groups, but there were more women with chronic hypertension in the HBPM group compared with the control group (49.1% vs 25.9%, P = 0.004). The HBPM group had significantly fewer outpatient attendances per patient (6.5 vs 8.0, P = 0.003) and this difference persisted when taking into account differences in duration of monitoring (0.8 vs 1.6 attendances per week, P < 0.001). There was no difference in the incidence of adverse maternal, fetal or neonatal outcome between the two groups. CONCLUSION HBPM in hypertensive pregnancies has the potential to reduce the number of hospital visits required by patients without compromising maternal and pregnancy outcomes. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H Perry
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - E Sheehan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - B Thilaganathan
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - A Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
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Magee LA, Kenny L, Ananth Karumanchi S, McCarthy F, Saito S, Hall DR, Warren CE, Adoyi G, Mohammed SI. TEMPORARY REMOVAL: The hypertensive disorders of pregnancy: ISSHP classification, diagnosis and management recommendations for international practice 2018. Pregnancy Hypertens 2018. [DOI: 10.1016/j.preghy.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tremonti C, Beddoe J, Brown MA. Reliability of home blood pressure monitoring devices in pregnancy. Pregnancy Hypertens 2017; 8:9-14. [DOI: 10.1016/j.preghy.2017.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/04/2017] [Accepted: 01/09/2017] [Indexed: 11/30/2022]
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McCarthy EA, Carins TA, Hannigan Y, Bardien N, Shub A, Walker SP. Effectiveness and safety of 1 vs 4 h blood pressure profile with clinical and laboratory assessment for the exclusion of gestational hypertension and pre-eclampsia: a retrospective study in a university affiliated maternity hospital. BMJ Open 2015; 5:e009492. [PMID: 26582404 PMCID: PMC4654395 DOI: 10.1136/bmjopen-2015-009492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/23/2015] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE We asked whether 60 compared with 240 min observation is sufficiently informative and safe for pregnancy day assessment (PDAC) of suspected pre-eclampsia (PE). DESIGN A retrospective study of 209 pregnant women (475 PDAC assessments, 6 months) with routinely collected blood pressure (BP), symptom and laboratory information. We proposed a 60 min screening algorithm comprising: absence of symptoms, normal laboratory parameters and ≤1high-BP reading (systolic blood pressure, SBP 140 mm Hg or higher or diastolic blood pressure, DBP 90 mm Hg or higher). We also evaluated two less inclusive screening algorithms. We determined short-term outcomes (within 4 h): severe hypertension, proteinuric hypertension and pregnancy-induced hypertension, as well as long-term outcome: PE-related diagnoses up to the early puerperium. We assessed performance of alternate screening algorithms performance using 2×2 tables. RESULTS 1 in 3 women met all screen negative criteria at 1 h. Their risk of hypertension requiring treatment in the next 3 h was 1.8% and of failing to diagnose proteinuric hypertensive PE at 4 h was 5.1%. If BP triggers were 5 mm Hg lower, 1 in 6 women would be screen-negative of whom 1.1% subsequently develops treatment-requiring hypertension and 4.5% demonstrate short-term proteinuric hypertension. We present sensitivity, specificity, negative and positive likelihood ratios for alternate screening algorithms. CONCLUSIONS We endorse further research into the safest screening test where women are considered for discharge after 60 min. Safety, patient and staff satisfaction should be assessed prospectively. Any screening test should be used in conjunction with good clinical care to minimise maternal and perinatal hazards of PE.
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Affiliation(s)
- Elizabeth Anne McCarthy
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Thomas A Carins
- Department of Emergency, Austin Health, Heidelberg, Victoria, Australia
| | - Yolanda Hannigan
- Department of Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Nadia Bardien
- Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Alexis Shub
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, Victoria, Australia
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Collén AC, Johansson MC, Guron CW, Gustafsson H, Manhem K. Cardiac structure and function is related to current blood pressure rather than to previous hypertensive pregnancy. J Hum Hypertens 2015; 29:702-4. [PMID: 26134623 DOI: 10.1038/jhh.2015.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A-C Collén
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M C Johansson
- Department of Molecular and Clinical Medicine/Clinical physiology, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - C W Guron
- Department of Molecular and Clinical Medicine/Clinical physiology, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Gustafsson
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K Manhem
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Salles GF, Schlüssel MM, Farias DR, Franco-Sena AB, Rebelo F, Lacerda EMA, Kac G. Blood pressure in healthy pregnancy and factors associated with no mid-trimester blood pressure drop: a prospective cohort study. Am J Hypertens 2015; 28:680-9. [PMID: 25376641 DOI: 10.1093/ajh/hpu204] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/25/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The well-known mid-trimester drop in blood pressure (BP) during normal pregnancy was recently questioned. OBJECTIVE To describe longitudinal changes in BP during healthy pregnancies and to investigate factors associated with no mid-trimester drop in BP. METHODS A prospective cohort with 158 healthy pregnant women was followed up in a public health care center in Rio de Janeiro, Brazil. We used linear mixed-effects models to estimate longitudinal changes in systolic BP (SBP) and diastolic BP (DBP) during pregnancy. Poisson regression models were performed to identify factors associated with no mid-trimester drop in BP. RESULTS Significant mid-trimester increase in SBP (5.6 mm Hg; 95% confidence interval (CI) = 4.6-6.7) and DBP (4.4 mm Hg; 95% CI = 3.4-5.3) was observed in 44.3% and 39.9% of the sample, respectively. Women (37.1%) who had not a mid-trimester SBP drop still had a DBP drop. White skin color (incidence ratio (IR): 1.71; 95% CI = 1.22-2.39), family history of hypertension (IR: 1.93; 95% CI = 1.29-2.89), early pregnancy obesity (IR: 2.29; 95% CI = 1.27-4.11), outside temperature variation (IR: 1.45; 95% CI = 1.00-2.10), and gestational weight gain from the first to second trimester (IR: 1.71; 95% CI = 1.01-2.88 and IR: 2.32; 95% CI = 1.39-3.89 for second and third tertiles) were characteristics associated with no mid-trimester drop in SBP. The same characteristics were associated with no mid-trimester drop in DBP, except family history of hypertension and outside temperature variation. CONCLUSIONS Some women without a mid-trimester SBP drop still present a DBP drop. The different patterns of mid-trimester change in BP seem to be determined by preexisting and pregnancy-related factors.
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Affiliation(s)
- Gil F Salles
- Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michael M Schlüssel
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Dayana R Farias
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Beatriz Franco-Sena
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda Rebelo
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Elisa M A Lacerda
- Department of Nutrition and Dietetics, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil;
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Dorogova IV, Panina ES. Comparison of the BPLab® sphygmomanometer for ambulatory blood pressure monitoring with mercury sphygmomanometry in pregnant women: validation study according to the British Hypertension Society protocol. Vasc Health Risk Manag 2015; 11:245-9. [PMID: 25926739 PMCID: PMC4403505 DOI: 10.2147/vhrm.s82381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to validate the automated BPLab® sphygmomanometer for ambulatory blood pressure monitoring (ABPM) in pregnant women according to Part II of the 1993 British Hypertension Society protocol. Pregnant women attending the antenatal clinic were randomly asked to participate (n=30). The BPLab sphygmomanometer was tested on pregnant women in this study and achieved A/A ratings according to the BHS protocol when compared with the "gold" standard of mercury sphygmomanometry. The device can therefore be recommended for use in pregnancy.
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Affiliation(s)
- Inna V Dorogova
- Penza Institute of Advanced Training for Physicians, Penza, Russia
| | - Elena S Panina
- Penza Institute of Advanced Training for Physicians, Penza, Russia
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Eguchi K, Ohmaru T, Ohkuchi A, Hirashima C, Takahashi K, Suzuki H, Kario K, Matsubara S, Suzuki M. Ambulatory BP monitoring and clinic BP in predicting small-for-gestational-age infants during pregnancy. J Hum Hypertens 2015; 30:62-7. [DOI: 10.1038/jhh.2015.20] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/07/2014] [Accepted: 01/08/2015] [Indexed: 11/09/2022]
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Tranquilli A, Dekker G, Magee L, Roberts J, Sibai B, Steyn W, Zeeman G, Brown M. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP. Pregnancy Hypertens 2014; 4:97-104. [DOI: 10.1016/j.preghy.2014.02.001] [Citation(s) in RCA: 802] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 02/03/2014] [Accepted: 02/03/2014] [Indexed: 12/15/2022]
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Regitz-Zagrosek V, Gohlke-Bärwolf C, Iung B, Pieper PG. Management of cardiovascular diseases during pregnancy. Curr Probl Cardiol 2014; 39:85-151. [PMID: 24794710 DOI: 10.1016/j.cpcardiol.2014.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The prevalence of cardiovascular diseases (CVDs) in women of childbearing age is rising. The successes in medical and surgical treatment of congenital heart disease have led to an increasing number of women at childbearing age presenting with problems of treated congenital heart disease. Furthermore, in developing countries and in immigrants from these countries, rheumatic valvular heart disease still plays a significant role in young women. Increasing age of pregnant women and increasing prevalence of atherosclerotic risk factors have led to an increase in women with coronary artery disease at pregnancy. Successful management of pregnancy in women with CVDs requires early diagnosis, a thorough risk stratification, and appropriate management by a multidisciplinary team of obstetricians, cardiologists, anesthesiologists, and primary care physicians. The following review is based on the recent European guidelines on the management of CVDs during pregnancy, which aim at providing concise and simple recommendations for these challenging problems.
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