Advertisement

Diurnal blood pressure variation in the evaluation of early onset severe pre-eclampsia

Published:September 05, 2007DOI:https://doi.org/10.1016/j.ejogrb.2007.08.010

      Abstract

      Objective

      : To study the association between diurnal variation in blood pressure, the mean daily blood pressure and various complications of pregnancy in patients presenting with severe pre-eclampsia before 34 weeks’ gestation.

      Study design

      : Forty-four women presenting to a tertiary hospital in South Africa with severe pre-eclampsia between 28 and 34 weeks’ gestation were managed expectantly for at least 8 days. We measured maternal blood pressure every 30 min with the pregnancy validated Spacelabs 90209 automated blood pressure monitor for 24 h periods on alternative days. The mean 24-h diastolic blood pressure measurement, the mean diastolic blood pressure for daytime and nighttime, the day–night blood pressure difference and the night–day ratio were compared with the occurrence of abruptio placentae, gestational age at delivery, neonatal intensive care unit admission, birth weight, abnormal umbilical artery Doppler FVW and reason for delivery.

      Results

      : One hundred and seventy-six 24-h studies were analyzed. The day–night blood pressure difference decreased with increasing mean diastolic blood pressure (r = −0.323, p < 0.0001). A combination of normal mean diastolic blood pressure and normal day–night blood pressure difference was associated with increased gestational age and lower caesarean section rates.

      Conclusion

      : The combination of mean diastolic blood pressure and day–night blood pressure difference may be a supplementary measurement of disease severity in early onset severe pre-eclampsia and seems to be of prognostic value.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • Naidu S.
        • Moodley J.
        • Adhikari M.
        • Ramsaroop R.
        • Morar N.
        • Dunmoye O.O.
        Clinico-pathological study of causes of perinatal mortality in a developing country.
        J Obstet Gynaecol. 2001; 21: 443-447
        • Duley L.
        Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean.
        Br J Obstet Gynaecol. 1992; 99: 547-553
      1. HMSO. Report on confidential enquiries into maternal deaths in the United Kingdom 1991–1993. HMSO, London, England, 1996.

        • Lain K.Y.
        • Roberts J.M.
        Contemporary concepts of the pathogenesis and management of preeclampsia.
        JAMA. 2002; 287: 3183-3186
        • Goldenberg R.L.
        • Rouse D.J.
        Prevention of premature birth.
        N Engl J Med. 1998; 339: 313-320
        • Hall D.R.
        • Odendaal H.J.
        • Steyn D.W.
        • Smith M.
        Nifedipine or prazosin as a second agent to control early severe hypertension in pregnancy: a randomised controlled trial.
        Br J Obstet Gynaecol. 2000; 107: 759-765
        • Steyn D.W.
        • Hall D.R.
        • Roberston M.
        • Kirsten G.F.
        Perinatal mortality in hypertension in pregnancy.
        Hypertens Pregnancy. 2000; 19: 157
        • Odendaal H.J.
        • Pattinson R.C.
        • Bam R.
        • Grove D.
        • Kotze T.J.
        Aggressive or expectant management for patients with severe pre-eclampsia between 28 and 34 weeks’ gestation: a randomized controlled trial.
        Obstet Gynecol. 1990; 76: 1070-1075
        • Sibai B.M.
        • Mercer B.M.
        • Schiff E.
        • Friedman S.A.
        Aggressive versus expectant management of severe preeclampsia at 28–32 weeks’ gestation: a randomized controlled trial.
        Am J Obstet Gynecol. 1994; 171: 818-822
        • Higgins J.R.
        • De Swiet M.
        Blood-pressure measurement and classification in pregnancy.
        Lancet. 2001; 357: 131-135
        • Shennan A.H.
        • Kissane J.
        • de Swiet M.
        Validation of the SpaceLabs 90207 ambulatory blood pressure monitor for use in pregnancy.
        Br J Obstet Gynaecol. 1993; 100: 904-908
        • Shennan A.
        • Halligan A.
        • Gupta M.
        • Taylor D.
        • de Swiet M.
        Oscilometric blood pressure measurements in severe pre-eclampsia: validation of the Spacelabs 90207.
        Br J Obstet Gynaecol. 1996; 103: 721-722
        • Coca A.
        Circadian rhythm and blood pressure control: physiological and pathophysiological factors.
        J Hypertens. 1994; 12: S13-S21
        • Manning G.
        • Rushton L.
        • Donnelly R.
        • Miller-Craig M.W.
        Variabilty of diurnal changes in ambulatory blood pressure and nocturnal dipping status in hypertensive and normotensive subjects.
        Am J Hypertens. 2000; 13: 1035-1038
        • Halligan A.
        • O’Brien E.
        • O’Malley K.
        • et al.
        Twenty-four-hour ambulatory blood pressure measurement in a primigravid population.
        J Hypertens. 1993; 11: 869-873
        • Brown M.A.
        • Robinson A.
        • Bowyer L.
        • et al.
        Ambulatory blood pressure monitoring in pregnancy: what is normal?.
        Am J Obstet Gynecol. 1998; 178: 836-842
        • Halligan A.
        • Shennan A.
        • Thurston H.
        • de Swiet M.
        • Taylor D.
        Ambulatory blood pressure measurement in Pregnancy: the current state of the art.
        Hypertens Pregnancy. 1995; 14: 1-16
        • Halligan A.
        • Shennan A.
        • Lambert P.C.
        • de Swiet M.
        • Taylor D.
        Diurnal blood pressure difference in the assessment of preeclampsia.
        Obstet Gynecol. 1996; 87: 205-208
        • Buchbinder A.
        • Sibai B.M.
        • Caritis S.
        • et al.
        Adverse perinatal outcomes are significantly higher in severe gestational hypertension than in mild preeclampsia.
        Am J Obstet Gynecol. 2002; 186: 66-71
        • Davey D.A.
        • MacGillivray I.
        The classification and definition of the hypertensive disorders of pregnancy.
        Am J Obstet Gynecol. 1988; 158: 892-898
        • Olofsson P.
        • Poulsen H.
        Reversed circadian blood pressure rhythm preserves fetal growth in preeclamptix pregnancy.
        Eur J Obstet Gyneacol Reprod Biol. 1997; 75: 133-138
        • Mallion J.M.
        • Baguet J.P.
        • Siche J.P.
        • Tremel F.
        • De Gaudemaris R.
        Clinical value of ambulatory blood pressure monitoring.
        J Hypertens. 1999; 17: 585-595
        • Brown M.A.
        • Davis G.K.
        • McHugh L.
        The prevalence and clinical significance of nocturnal hypertension in pregnancy.
        J Hypertens. 2001; 19: 1437-1444
        • Bellomo G.
        • Narducci P.L.
        • Rondoni F.
        Prognostic value of 24-h blood pressure in pregnancy.
        JAMA. 1999; 282: 1447-1452
        • Halligan A.W.F.
        • Shennan A.
        • Lambert P.C.
        • Taylor D.J.
        • de Swiet M.
        Automated blood pressure measurement as a predictor of proteinuric pre-eclampsia.
        Br J Obstet Gynaecol. 1997; 104: 559-562
        • Chua S.
        • Redman C.W.
        Prognosis for pre-eclampsia complicated by 5 g or more of proteinuria in 24 h.
        Eur J Obstet Gynecol Reprod Biol. 1992; 43: 9-12
        • Schiff E.
        • Friedman S.A.
        • Kao L.
        • Sibai B.M.
        The importance of urinary protein excretion during conservative management of severe pre-eclampsia.
        Am J Obstet Gynecol. 1996; 175: 1313-1316
        • Hall D.R.
        • Odendaal H.J.
        • Steyn D.W.
        • Grove D.
        Urinary protein excretion and expectant management of early onset, severe pre-eclampsia.
        Int J Gynecol Obstet. 2002; 77: 1-6
        • O’Brien E.
        • Coats A.
        • Owens P.
        • et al.
        Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British Hypertension Society.
        BMJ. 2000; 320: 1128-1134