Document Detail


Prognostic value of 24-hour blood pressure in pregnancy.
MedLine Citation:
PMID:  10535435     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Elevated blood pressure (BP) measured at the physician's office may reflect true hypertension or white coat hypertension (WCH). The prognostic value of WCH among pregnant women is unknown.
OBJECTIVE: To assess the prognostic value of WCH in pregnancy.
DESIGN: Prospective cohort study conducted between September 1994 and October 1997.
SETTING: Community hospital.
PATIENTS: Women without preexisting hypertension and not treated with antihypertensive drugs aid with high (n = 148) or normal (n = 106) office BP (high office BP was defined as > or =140 mm Hg systolic and/or > or =90 mm Hg diastolic) matched for gestational age during their third trimester of pregnancy. All women underwent 24-hour noninvasive BP monitoring, and women without hypertension on 24-hour monitoring (125/74 mm Hg or less for average 24-hour BP) with office hypertension were classified as having WCH. Women were followed up through the end of pregnancy.
MAIN OUTCOME MEASURES: Duration of pregnancy, gestational hypertension, preeclampsia or eclampsia, cesarean delivery, placental and neonatal weight, and length of maternal and neonatal hospital stays for those with and without elevated office BP.
RESULTS: After application of exclusion criteria, data for 7 women were removed from the analysis. For the remaining subjects, in the group with elevated BP, prevalence of WCH was 29.2% (42/144). Duration of pregnancy was similar in the normotensive and WCH groups (39.6 vs 39.8 weeks; P = .50), but shorter (38.3 weeks; P<.001) in the true hypertension group. Incidence of preeclampsia was similar in the normotensive and WCH groups (5.8% vs 7.1 %; P = .86) but higher in the true hypertension group (61.7%; P<.001). Frequency of cesarean delivery was lower in the normotensive (12.4%) than in the WCH (45.2%; P = .008) and true hypertension (41.1 %; P = .009) groups. Neonatal weight was lower (P<.001) in the true hypertension (mean, 2911 g) than in the normotensive (3336 g) and WCH groups (3435 g), which did not differ (P = .68). The duration of neonatal hospital stay did not differ between the normotensive and the WCH group (5.3 vs 6.9 days; P = .13) but was longer in the true hypertension group (12.3 days; P<.001).
CONCLUSIONS: In women with elevated BP during their third trimester of pregnancy, 24-hour BP was superior to office BP (distinguishing true hypertension from WCH) for prediction of the outcome of pregnancy. Outcomes in the normotensive and WCH group were comparable, but the increased incidence of cesarean delivery in the WCH group may reflect decision-making processes influenced by office BP.
Authors:
G Bellomo; P L Narducci; F Rondoni; G Pastorelli; G Stangoni; G Angeli; P Verdecchia
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Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  JAMA     Volume:  282     ISSN:  0098-7484     ISO Abbreviation:  JAMA     Publication Date:  1999 Oct 
Date Detail:
Created Date:  1999-10-28     Completed Date:  1999-10-28     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1447-52     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Pressure Monitoring, Ambulatory*
Female
Humans
Hypertension / diagnosis*,  epidemiology,  prevention & control
Office Visits
Pregnancy
Pregnancy Complications, Cardiovascular / diagnosis*,  epidemiology,  prevention & control
Pregnancy Outcome
Pregnancy Trimester, Third
Prognosis
Prospective Studies
Sensitivity and Specificity
Sphygmomanometers
Comments/Corrections
Erratum In:
JAMA 2000 May 3;283(17):2241

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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