Blunted Overnight Blood Pressure Dipping in Second Trimester; A Strong Predictor of Gestational Hypertension and Preeclampsia

Author(s): Abo Taleb Saremi, Mohammad-Ali Shafiee*, Mahdi Montazeri, Negin Rashidi, Mohammad Montazeri

Journal Name: Current Hypertension Reviews

Volume 15 , Issue 1 , 2019

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Graphical Abstract:


Background: Preeclampsia is a global burden with 10 million incidences annually and 210 daily deaths worldwide. Diagnosis is mainly based on the features following full presentation.

Objective: This study explored whether early pregnancy circadian changes of ambulatory blood pressure monitoring (ABPM) could predict preeclampsia and hypertension.

Methods: In a prospective study, 294 pregnant women who were referred to Sarem Women’s Hospital, Iran were recruited. Systolic, diastolic and mean arterial pressures (MAP) were recorded (diurnally and nocturnally) in each trimester. Dipping was defined as a minimum 10% decrease in blood pressure.

Results: Of the 251 women who completed the study, 25 percent (n=63) experienced blunted MAP dipping during sleep phases in the second trimester. Eighty-nine percent (n=56) experienced hypertensive disorder in the third trimester, one-third of which experienced preeclampsia. Of the women with normal MAP dipping (n=188), 5 percent (n=10) had gestational hypertension and 1 percent (n=2) became preeclamptic. (P<0.0001).

Conclusion: This study clearly demonstrated blunted blood pressure dipping overnight during the second trimester which is a strong predictor of forthcoming pregnancy-induced hypertension and preeclampsia. A scoring system was developed to predict hypertensive disorder and it was significantly correlated with preeclampsia occurrence.

Keywords: Ambulatory blood pressure monitoring, dipping, hypertension, preeclampsia, pregnancy.

World Health Organization Fact Sheet. May 2012
Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2(6): e323-33.
Jeyabalan A. Epidemiology of preeclampsia: Impact of obesity. Nutr Rev 2013; 71(Suppl. 1): S18-25.
Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol 2009; 33(3): 130-7.
Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertens 2014; 4(2): 105-45.
Warrington JP, George EM, Palei AC, Spradley FT, Granger JP. Recent advances in the understanding of the pathophysiology of preeclampsia Hypertension (Dallas, Tex : 1979) 2013; 62(4): 666-73
Maynard SE, Min JY, Merchan J, et al. Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J Clin Invest 2003; 111(5): 649-58.
Lam C, Lim KH, Karumanchi SA. Circulating angiogenic factors in the pathogenesis and prediction of preeclampsia Hypertension (Dallas, Tex : 1979) 2005; 46(5): 1077-8
Hering L, Herse F, Geusens N, et al. Effects of circulating and local uteroplacental angiotensin II in rat pregnancyHypertension (Dallas, Tex : 1979) 2010; 56(2): 311-8
Parati G, Mutti E, Ravogli A, Trazzi S, Villani A, Mancia G. Advantages and disadvantages of non-invasive ambulatory blood pressure monitoring. J Hypertens Suppl 1990; 8(6): S33-8.
Meads CA, Cnossen JS, Meher S, et al. Methods of prediction and prevention of pre-eclampsia: systematic reviews of accuracy and effectiveness literature with economic modellingHealth Technol Assessment (Winchester, England) 2008; 12(6): iii-iv, 1-270
Hermida RC, Ayala DE. Sampling requirements for ambulatory blood pressure monitoring in the diagnosis of hypertension in pregnancyHypertension (Dallas, Tex : 1979) 2003; 42(4): 619-24
Bloomfield D, Park A. Night time blood pressure dip. World J Cardiol 2015; 7(7): 373-6.
O’Brien E, Sheridan J, O’Malley K. Dippers and non-dippers. Lancet (London, England) 1988; 2(8607): 397.
Mousa T, el-Sayed MA, Motawea AK, Salama MA, Elhendy A. Association of blunted nighttime blood pressure dipping with coronary artery stenosis in men. Am J Hypertens 2004; 17(10): 977-80.
Leung AA, Nerenberg K, Daskalopoulou SS, et al. Hypertension Canada’s 2016 Canadian Hypertension Education Program Guidelines for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol 2016; 32(5): 569-88.
Alpert BS. Validation of the Tiba Medical Ambulo 2400 ambulatory blood pressure monitor to the ISO Standard and BHS protocol. Blood Press Monit 2010; 15(5): 275-7.
Kyle PM, Clark SJ, Buckley D, et al. Second trimester ambulatory blood pressure in nulliparous pregnancy: A useful screening test for pre-eclampsia? Br J Obstet Gynaecol 1993; 100(10): 914-9.
Pickering TG. How should the diurnal changes of blood pressure be expressed? Am J Hypertens 1995; 8(7): 681-2.
Beilin LJ, Deacon J, Michael CA, et al. Circadian rhythms of blood pressure and pressor hormones in normal and hypertensive pregnancy. Clin Exp Pharmacol Physiol 1982; 9(3): 321-6.
Brown MA, Robinson A, Bowyer L, et al. Ambulatory blood pressure monitoring in pregnancy: What is normal? Am J Obstet Gynecol 1998; 178(4): 836-42.
Hermida RC, Ayala DE, Mojon A, et al. Blood pressure patterns in normal pregnancy, gestational hypertension, and preeclampsiaHypertension (Dallas, Tex: 1979) 2000; 36(2): 149-58
Hermida RC, Ayala DE, Mojon A, et al. Differences in circadian blood pressure variability during gestation between healthy and complicated pregnancies. Am J Hypertens 2003; 16(3): 200-8.
Benedetto C, Zonca M, Marozio L, Dolci C, Carandente F, Massobrio M. Blood pressure patterns in normal pregnancy and in pregnancy-induced hypertension, preeclampsia, and chronic hypertension. Obstet Gynecol 1996; 88(4 Pt 1): 503-10.
Gupta HP, Singh RK, Singh U, Mehrotra S, Verma NS, Baranwal N. Circadian pattern of blood pressure in normal pregnancy and preeclampsia. J Obstet Gynaecol India 2011; 61(4): 413-7.

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Article Details

Year: 2019
Published on: 24 September, 2018
Page: [70 - 75]
Pages: 6
DOI: 10.2174/1573402114666180924143801
Price: $65

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