Is There an Association Between Second Trimester Blood Pressure and Pregnancy-Induced Hypertensive Disorders? [19L

Abstract

INTRODUCTION: In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) revised the guidelines for abnormal blood pressure (BP): elevated (120-129/<80), stage 1 (130-139/80-89) and stage 2 hypertension (≥140/90) on ≥2 occasions in adults. This study aims to determine a relationship between elevated and stage 1 ACC/AHA hypertension in the second trimester and pregnancy-induced hypertensive disorders (PIH). METHODS: In this IRB approved retrospective cohort study, we collected the highest two blood pressure measurements in second trimester for singleton pregnancies prior to the ACOG diagnosis of PIH (gestational hypertension, preeclampsia, HELLP, eclampsia). Patients were grouped by ACC/AHA criteria and compared using Pearson chi-square tests, Fisher’s exact tests, T-tests or Mann-Whitney U tests. RESULTS: 200 patients were included; 54.9% had normal BP, 10.5% had elevated BP, and 34% had stage 1 ACC/AHA hypertension. There was no association between the severity of PIH and normal versus elevated/stage 1 BP in second trimester. Among those with elevated/stage 1 hypertension, gestational age was significantly lower at diagnosis of PIH (P<.001) and delivery (P<.001) compared to normotensive patients. CONCLUSION: Gestational age at PIH diagnosis and delivery were significantly lower among women with ACC/AHA elevated or stage 1 hypertension in second trimester compared to normotensive women. Therefore, further research is warranted to determine a relationship between the ACC/AHA guidelines for hypertension and PIH with the possibility of earlier recognition of the disease and intervention.