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Nocturnal hypertension in high-risk mid-pregnancies predict the development of preeclampsia/eclampsia

Salazar, Martin R.a,b; Espeche, Walter G.a,b; Leiva Sisnieguez, Carlos E.a,b; Leiva Sisnieguez, Betty C.a,b; Balbín, Eduardoa; Stavile, Rodolfo N.a,b; March, Carlosa,b; Olano, Ricardo D.b; Soria, Adelaidac; Yoma, Osvaldoc; Prudente, Marceloc; Torres, Soledadc; Grassi, Florenciac; Santillan, Claudiac; Carbajal, Horacio A.b

doi: 10.1097/HJH.0000000000001848

Objective: The aim of this study was to test if hypertension detected by ambulatory blood pressure monitoring (ABPM) performed at mid-pregnancy, is a useful predictor for preeclampsia/eclampsia (PEEC).

Methods: The study was performed in women coursing high-risk mid-pregnancies. Office blood pressure (BP) was estimated as the mean of three values, taken by a specialized nurse after a 15-min interview, and office hypertension defined as at least 140/90 mmHg. Immediately after, an ABPM was started. Diurnal hypertension was defined as ABPM at least 135/85 mmHg during daily activities, nocturnal hypertension as ABPM at least 120/70 mmHg during night rest. The adjusted risk of PEEC was estimated using logistic regression.

Results: Eighty-seven women (mean age 31 ± 7 years) with 23 ± 2 weeks of pregnancy were included. The prevalence of office and ABPM hypertension was 13.8 and 40.2%, respectively. The concordance between both hypertension diagnosis was low (κ = 0.170, P = 0.044). Nocturnal hypertension (35.6%) was more frequent than diurnal hypertension (26.4%). Nocturnal hypertension markedly increased the relative risk of PEEC (OR 5.32, 95% CI 1.48–19.10). The risk of PEEC attributed to diurnal hypertension did not reach statistical significance; and when both, diurnal and nocturnal hypertension were included in the same model, only the second one was a significant predictor (P = 0.012). The relative risk associated with nocturnal hypertension increased for women not taking acetylsalicylic acid (ASA); (OR 11.40, 95% CI 2.35–55.25).

Conclusion: Nocturnal hypertension at high-risk mid-pregnancy is a frequent condition and a strong predictor for PEEC; the risk doubled for women not taking ASA.

aUnidad de Enfermedades Cardiometabólicas, Servicio de Clínica Médica, Hospital Gral. San Martín

bFacultad de Ciencias Médicas, UNLP

cServicio de Obstetricia, Hospital Gral. San Martín, La Plata, Buenos Aires, Argentina

Correspondence to Martin R. Salazar, MD, Hospital Universitario San Martín, Calle 14 n 320, La Plata 1900, Buenos Aires, Argentina. Tel: +54 221 4242625; fax: +54 221 4129164; e-mail:

Abbreviations: ABPM, ambulatory blood pressure monitoring; BP, blood pressure; OR, odds-ratio; PEEC, preeclampsia/eclampsia; SD, standard deviation

Received 30 March, 2018

Revised 22 May, 2018

Accepted 6 June, 2018

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