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
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 coh...
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| Published in | Hypertension (Dallas, Tex. 1979) Vol. 76; no. 6; pp. 1800 - 1807 |
|---|---|
| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
American Heart Association, Inc
01.12.2020
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| Abstract | 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. |
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| AbstractList | 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 (first: 4.8±1.3 versus 3.7±1.2,
=0.001; second: 5.1±1.8 versus 3.8±1.1,
=0.02; third: 5.2±0.8 versus 4.0±1.1 mm Hg,
=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;
=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;
=0.002) and was associated with BPV after adjustment for mean blood pressure (
=0.26;
=0.005). First trimester baroreflex sensitivity did not differ between groups (
=0.23) and was not related to BPV (
=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. 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. 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 (first: 4.8±1.3 versus 3.7±1.2, P =0.001; second: 5.1±1.8 versus 3.8±1.1, P =0.02; third: 5.2±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. 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 (BP) recordings via finger photoplethysmography in the first, second and third trimesters. Aortic stiffness (carotid-femoral pulse wave velocity, cfPWV) and spontaneous cardiovagal baroreflex sensitivity (BRS) were also measured each trimester. Eighteen women (13%) developed preeclampsia. Systolic BPV was higher in all trimesters among women who developed vs. did not develop preeclampsia (1 st : 4.8±1.3 versus 3.7±1.2, P =0.001; 2 nd : 5.1±1.8 versus 3.8±1.1, P =0.02; 3 rd : 5.2±0.8 versus 4.0±1.1 mmHg, P =0.002). Elevated first trimester systolic BPV was associated with preeclampsia (OR: 1.94, 95%CI 1.27–2.99), even after adjusting for risk factors (age, body mass index, systolic BP, history of preeclampsia and diabetes mellitus) and was a significant predictor of preeclampsia (receiver operating characteristic analysis, AUC=0.75±0.07; P =0.002). cfPWV 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 BP (r=0.26; P =0.005). First trimester BRS 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. Early pregnancy elevations in beat-to-beat blood pressure variability is independently associated with late pregnancy onset of overt preeclampsia and may be modulated in part by higher aortic stiffness. |
| Author | Stroud, Amy K. Scroggins, Sabrina M. DuBose, Lyndsey E. Luehrs, Rachel E. Santillan, Donna A. Grobe, Justin L. Pierce, Gary L. Santillan, Mark K. Sigmund, Curt D. Betz, Alexandria M. Brandt, Debra Fiedorowicz, Jess G. Nuckols, Virginia R. Holwerda, Seth W. |
| AuthorAffiliation | From the Departments of Health and Human Physiology (V.R.N., S.W.H., R.E.L., L.E.D., A.K.S., G.L.P.), University of Iowa, Iowa City, IA Obstetrics and Gynecology (D.B., A.M.B., S.M.S., D.A.S., M.K.S.), University of Iowa, Iowa City, IA Psychiatry (J.G.F.), University of Iowa, Iowa City, IA Epidemiology (J.G.F.), University of Iowa, Iowa City, IA Internal Medicine (J.G.F.), University of Iowa, Iowa City, IA the Abboud Cardiovascular Research Center (S.W.H., M.K.S., G.L.P.), University of Iowa, Iowa City, IA Fraternal Order of Eagles Diabetes Research Center (G.L.P.), University of Iowa, Iowa City, IA Departments of Physiology (J.L.G., C.D.S.), Medical College of Wisconsin, Milwaukee, WI. Biomedical Engineering (J.L.G.), Medical College of Wisconsin, Milwaukee, WI. Cardiovascular Research Center (J.L.G., C.D.S.), Medical College of Wisconsin, Milwaukee, WI |
| AuthorAffiliation_xml | – name: From the Departments of Health and Human Physiology (V.R.N., S.W.H., R.E.L., L.E.D., A.K.S., G.L.P.), University of Iowa, Iowa City, IA Obstetrics and Gynecology (D.B., A.M.B., S.M.S., D.A.S., M.K.S.), University of Iowa, Iowa City, IA Psychiatry (J.G.F.), University of Iowa, Iowa City, IA Epidemiology (J.G.F.), University of Iowa, Iowa City, IA Internal Medicine (J.G.F.), University of Iowa, Iowa City, IA the Abboud Cardiovascular Research Center (S.W.H., M.K.S., G.L.P.), University of Iowa, Iowa City, IA Fraternal Order of Eagles Diabetes Research Center (G.L.P.), University of Iowa, Iowa City, IA Departments of Physiology (J.L.G., C.D.S.), Medical College of Wisconsin, Milwaukee, WI. Biomedical Engineering (J.L.G.), Medical College of Wisconsin, Milwaukee, WI. Cardiovascular Research Center (J.L.G., C.D.S.), Medical College of Wisconsin, Milwaukee, WI – name: 2 Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA – name: 5 Department of Internal Medicine, University of Iowa, Iowa City, IA – name: 9 Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI – name: 4 Department of Epidemiology, University of Iowa, Iowa City, IA – name: 7 Department of Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA – name: 1 Department of Health and Human Physiology, University of Iowa, Iowa City, IA – name: 10 Department of Cardiovascular Research Center, Medical College of Wisconsin, Milwaukee, WI – name: 3 Department of Psychiatry, University of Iowa, Iowa City, IA – name: 6 Department of Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA – name: 8 Department of Physiology, Medical College of Wisconsin, Milwaukee, WI |
| Author_xml | – sequence: 1 givenname: Virginia surname: Nuckols middlename: R. fullname: Nuckols, Virginia R. organization: From the Departments of Health and Human Physiology (V.R.N., S.W.H., R.E.L., L.E.D., A.K.S., G.L.P.), University of Iowa, Iowa City, IA Obstetrics and Gynecology (D.B., A.M.B., S.M.S., D.A.S., M.K.S.), University of Iowa, Iowa City, IA Psychiatry (J.G.F.), University of Iowa, Iowa City, IA Epidemiology (J.G.F.), University of Iowa, Iowa City, IA Internal Medicine (J.G.F.), University of Iowa, Iowa City, IA the Abboud Cardiovascular Research Center (S.W.H., M.K.S., G.L.P.), University of Iowa, Iowa City, IA Fraternal Order of Eagles Diabetes Research Center (G.L.P.), University of Iowa, Iowa City, IA Departments of Physiology (J.L.G., C.D.S.), Medical College of Wisconsin, Milwaukee, WI. Biomedical Engineering (J.L.G.), Medical College of Wisconsin, Milwaukee, WI. Cardiovascular Research Center (J.L.G., C.D.S.), Medical College of Wisconsin, Milwaukee, WI – sequence: 2 givenname: Seth surname: Holwerda middlename: W. fullname: Holwerda, Seth W. – sequence: 3 givenname: Rachel surname: Luehrs middlename: E. fullname: Luehrs, Rachel E. – sequence: 4 givenname: Lyndsey surname: DuBose middlename: E. fullname: DuBose, Lyndsey E. – sequence: 5 givenname: Amy surname: Stroud middlename: K. fullname: Stroud, Amy K. – sequence: 6 givenname: Debra surname: Brandt fullname: Brandt, Debra – sequence: 7 givenname: Alexandria surname: Betz middlename: M. fullname: Betz, Alexandria M. – sequence: 8 givenname: Jess surname: Fiedorowicz middlename: G. fullname: Fiedorowicz, Jess G. – sequence: 9 givenname: Sabrina surname: Scroggins middlename: M. fullname: Scroggins, Sabrina M. – sequence: 10 givenname: Donna surname: Santillan middlename: A. fullname: Santillan, Donna A. – sequence: 11 givenname: Justin surname: Grobe middlename: L. fullname: Grobe, Justin L. – sequence: 12 givenname: Curt surname: Sigmund middlename: D. fullname: Sigmund, Curt D. – sequence: 13 givenname: Mark surname: Santillan middlename: K. fullname: Santillan, Mark K. – sequence: 14 givenname: Gary surname: Pierce middlename: L. fullname: Pierce, Gary L. |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32951467$$D View this record in MEDLINE/PubMed |
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| SubjectTerms | 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 |
| Title | 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 |
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