Beat-to-Beat Blood Pressure Variability in the First Trimester Is Associated With the Development of Preeclampsia in a Prospective Cohort: Relation With Aortic Stiffness

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 76; no. 6; pp. 1800 - 1807
• Main Authors: Nuckols, Virginia R., Holwerda, Seth W., Luehrs, Rachel E., DuBose, Lyndsey E., Stroud, Amy K., Brandt, Debra, Betz, Alexandria M., Fiedorowicz, Jess G., Scroggins, Sabrina M., Santillan, Donna A., Grobe, Justin L., Sigmund, Curt D., Santillan, Mark K., Pierce, Gary L.
• Format: Journal Article
• Language: English
• Published: United States American Heart Association, Inc 01.12.2020
• Subjects: Adolescent; Adult; Aorta - physiopathology; Baroreflex - physiology; Blood Pressure - physiology; Blood Pressure Determination; Female; Humans; Hypertension - diagnosis; Hypertension - physiopathology; Logistic Models; Pre-Eclampsia - diagnosis; Pre-Eclampsia - physiopathology; Pregnancy; Pregnancy Trimester, Third - physiology; Prospective Studies; Risk Factors; Vascular Stiffness - physiology; Young Adult; blood pressure; preeclampsia; baroreflex; hypertension; carotid-femoral pulse wave velocity
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/HYPERTENSIONAHA.120.15019

Women with preeclampsia, a hypertensive disorder of pregnancy, exhibit greater beat-to-beat blood pressure variability (BPV) in the third trimester after clinical onset of the disorder. However, it remains unknown whether elevated BPV precedes the development of preeclampsia. A prospective study cohort of 139 women (age 30.2±4.0 years) were enrolled in early pregnancy (<14 weeks gestation). BPV was quantified by time domain analyses of 10-minute continuous beat-to-beat blood pressure recordings via finger photoplethysmography in the first, second, and third trimesters. Aortic stiffness (carotid-femoral pulse wave velocity) and spontaneous cardiovagal baroreflex sensitivity were also measured each trimester. Eighteen women (13%) developed preeclampsia. Systolic BPV was higher in all trimesters among women who developed versus did not develop preeclampsia (first4.8±1.3 versus 3.7±1.2, P=0.001; second5.1±1.8 versus 3.8±1.1, P=0.02; third5.2±0.8 versus 4.0±1.1 mm Hg, P=0.002). Elevated first trimester systolic BPV was associated with preeclampsia (odds ratio, 1.94 [95% CI, 1.27–2.99]), even after adjusting for risk factors (age, body mass index, systolic blood pressure, history of preeclampsia, and diabetes mellitus) and was a significant predictor of preeclampsia (area under the receiver operator characteristic curve=0.75±0.07; P=0.002). Carotid-femoral pulse wave velocity was elevated in the first trimester among women who developed preeclampsia (5.9±0.8 versus 5.2±0.8 m/s; P=0.002) and was associated with BPV after adjustment for mean blood pressure (r=0.26; P=0.005). First trimester baroreflex sensitivity did not differ between groups (P=0.23) and was not related to BPV (P=0.36). Elevated systolic BPV is independently associated with the development of preeclampsia as early as the first trimester, possibly mediated in part by higher aortic stiffness.