Postpartum ambulatory and home blood pressure monitoring in women with history of preeclampsia: Diagnostic agreement and detection of masked hypertension
•Women with a history of preeclampsia are at elevated risk for postpartum hypertension.•Masked hypertension is missed without out-of-office blood pressure monitoring.•Home blood pressure is concordant with gold-standard ambulatory blood pressure postpartum.•We show that home blood pressure detects a...
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Published in | Pregnancy hypertension Vol. 29; pp. 23 - 29 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
Netherlands
Elsevier B.V
01.08.2022
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Subjects | |
Online Access | Get full text |
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Summary: | •Women with a history of preeclampsia are at elevated risk for postpartum hypertension.•Masked hypertension is missed without out-of-office blood pressure monitoring.•Home blood pressure is concordant with gold-standard ambulatory blood pressure postpartum.•We show that home blood pressure detects and predicts masked hypertension.•Home blood pressure may be a well-tolerated screening tool for overt or masked hypertension postpartum.
Women with a history of preeclampsia (hxPE) are at a four-fold higher risk for chronic hypertension after pregnancy compared with healthy pregnancy, but ‘masked’ hypertension cases are missed by clinical assessment alone. Twenty-four hour ambulatory blood pressure monitoring (ABPM) is the reference-standard for confirmation of hypertension diagnoses or detection of masked hypertension outside of clinical settings, whereas home blood pressure monitoring (HBPM) may represent a well-tolerated and practical alternative to ABPM in the postpartum period. The objectives of this study were to 1) assess concordance between ABPM and HBPM postpartum in women with a hxPE compared with healthy pregnancy controls and 2) evaluate HBPM in the detection of masked postpartum hypertension. Young women with a hxPE (N = 26) and controls (N = 36) underwent in-office, 24-h ABPM and 7-day HBPM 1–4 years postpartum. Chronic hypertension was more prevalent among women with a hxPE by all three blood pressure measures, but the prevalence of masked postpartum hypertension did not differ (36% vs 37%, P = 0.97). HBPM showed excellent agreement with ABPM (systolic: r = 0.78, intraclass coefficient [ICC] = 0.83; diastolic: r = 0.82, ICC = 0.88) and moderate concordance in classification of hypertension (κ = 0.54, P < 0.001). HBPM identified 21% of masked postpartum hypertension cases without false-positive cases, and HBPM measures among those with normotensive in-office readings could detect ABPM-defined masked hypertension (area under the curve [AUC] = 0.88 ± 0.06, P < 0.0001). The findings of the present study indicate that HBPM may be a useful screening modality prior or complementary to ABPM in the detection and management of postpartum hypertension. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 2210-7789 2210-7797 |
DOI: | 10.1016/j.preghy.2022.05.003 |