COMPARISON OF BLOOD PRESSURE VALUES IN PREGNANT HYPERTENSIVES AND NORMOTENSIVE CONTROLS WITH NORMAL PREGNANCY USING SERIAL AMBULATORY BLOOD PRESSURE MONITORING

Abstract

Objective: Although ambulatory blood pressure monitoring (ABPM) is recommended in pregnant patients with hypertension, few data are available on ABPM values and targets in pregnant hypertensives and in normal normotensive pregnancies. The aim of the study was to evaluate blood pressure (BP) values in normotensive and treated hypertensive pregnant patients using serial ABPM throughout the pregnancy. Design and method: We studied 79 patients with hypertension during pregnancy and 60 healthy pregnant women. In both groups, ABPM was performed at 5, 10, 15, 20, 25, 30, 33, 35, and 37 weeks of gestation. In pregnant hypertensives, drug treatment was initiated of intensified when the mean ambulatory BP was >130/80 mmHg and/or maximum office BP was >160/100 mmHg. Most patients were treated with methyldopa (500–2000 mg/d) and/or labetalol (100–600 mg/d). Healthy pregnant women did not receive any medications except for folic acid. BP values are reported as mean 24-hour ambulatory values in a given group at specific weeks of measurement listed above. Results: The mean ambulatory BP throughout the pregnancy was 122.7–129.0/76.8–79.9 mmHg in pregnant hypertensives and 101.8–115.8/63.4–71.9 mmHg in healthy pregnant women. In pregnant hypertensives, there were 78 singleton pregnancies and one multiple pregnancy. All children were born alive (33 by vaginal delivery, 46 by cesarean section) and were well during further follow-up. The mean gestational age at birth was 38.0 ± 2.1 weeks (range 29–40 weeks), and birth weight was 3242 ± 546 g (range 955–4200 g). No preeclampsia or eclampsia was observed. In healthy pregnant women, there were 60 singleton pregnancies. All children were born alive (23 by vaginal delivery, 37 by cesarean section). The mean gestational age at birth was 38.9 ± 1.9 weeks, and birth weight was 3346 ± 126 g. No complications of pregnancy were observed. Conclusions: In hypertensive women, ambulatory BP was well controlled throughout the pregnancy. No adverse pregnancy outcomes were observed. Ambulatory BP was lower in healthy pregnant women, while gestational age at birth, birth weight, and the proportion of cesarean deliveries were similar in both groups.