14 Central blood pressures and arterial stiffness in hypertensive pregnancies

Abstract

Introduction Cardiovascular disease has a stronger association with central BP than brachial (conventional) BP. Women with hypertensive disorders in pregnancy are at increased risk of cardiovascular disease later in life and may have a pre-existing phenotype of increased risk, un-masked by pregnancy. It is unclear whether central BP is altered in all hypertensive pregnancies or just pre-eclampsia. Objectives To examine central blood pressure and vascular stiffness in normal and hypertensive pregnancies. Methods Four groups of 3rd trimester women were studied: normotensive pregnancy (NP); gestational hypertension (GH); essential hypertension (EH), pre-eclampsia (PE) as well as non-pregnant controls (C). Each woman had central blood pressures and Augmentation index (as a measure of arterial stiffness) measured by using the Sphygmocor® applanation tonometer. Results A total of 128 women have been recruited in an ongoing study as follows; NP = 20, GH = 51, EH = 16, PE = 14 and C = 27. Neither mean brachial or central systolic and diastolic BPs differed between the non-pregnant and the normal pregnant cohort. Mean brachial BP 116 ± 11/74 ± 8 mmHg vs 119 ± 7/75 ± 8 mmHg and central 103 ± 11/75 ± 8 mmHg vs 105 ± 9/77 ± 8 mmHg. Normotensive pregnant women had significantly lower brachial and central blood pressures than any of the hypertensive pregnant women ( p Augmentation index (AI) was elevated in all pregnant women NP 14 ± 15, GH 20 ± 9, EH 19 ± 10, PE 18 ± 8, cf the control group 9 ± 13, with a trend towards being highest in women with GH and EH, however all remained below the upper limit of normal for that age group( Conclusions These data confirm that in pregnancy central blood pressure measurements are significantly lower than brachial measurements. Pregnant women appear to have a higher AI than non pregnant controls with a trend towards higher values suggestive of vascular stiffness in those women with GH and PE however they remained below the upper limit of normal for this small cohort