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  • Title: Office blood pressure values and the necessity of out-of-office measurements in high-risk pregnancies.
    Author: Salazar MR, Espeche WG, Balbín E, Leiva Sisnieguez CE, Leiva Sisnieguez BC, Stavile RN, March C, Olano RD, Soria A, Yoma O, Prudente M, Torres S, Grassi F, Santillan C, Carrera Ramos P, Carbajal HA.
    Journal: J Hypertens; 2019 Sep; 37(9):1838-1844. PubMed ID: 31157745.
    Abstract:
    OBJECTIVES: To determine if there is an office blood pressure (BP) value below which out-of-office measurements are unnecessary in high-risk pregnant women. METHODS: We conducted a prospective cohort study in women in the second half of high-risk pregnancies. Office BP measurements and ambulatory blood pressure monitoring (ABPM) was performed. The cohort was divided according to quartiles of office BP and in normotension, white-coat hypertension, masked hypertension and sustained hypertension. The risks for preeclampsia/eclampsia for each category were estimated. RESULTS: Three hundred seventy-three women (30 ± 7 years with 32 ± 4 weeks of gestation) were included; 69 women (18.5%) developed preeclampsia/eclampsia. Risk for preeclampsia/eclampsia increased in a stepwise manner through quartiles of systolic office BP (8.8, 13.4, 19.6 and 32.3%, P < 0.001) and diastolic office BP (6.5, 13.7, 19.6 and 34,4%, P < 0.001). OR increased significantly through quartiles of systolic (P = 0.004) and diastolic (P < 0.001) office BP; the significance becomes evident between the second and third quartile, the cut-off point between these was 125/76 mmHg. Prevalence of white-coat and masked hypertension were 3.8 and 24.7%, respectively. Using ABPM, 14/61 office hypertensive women were reclassified as white-coat hypertension but 92/312 normotensive women as masked hypertension. OR for preeclampsia/eclampsia increased significantly in women with masked hypertension. Absolute risk for preeclampsia/eclampsia in women with office BP less than 125/75 mmHg was similar than that in women with normal ABPM, 7.2 and 7.1%, respectively. CONCLUSION: Masked hypertension was a prevalent and high-risk condition. Office BP at least 125/75 mmHg in the second half of gestation seems appropriate to indicate out-of-office measurements in high-risk pregnancies.
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