Postpartum ambulatory and home blood pressure monitoring in women with history of preeclampsia: Diagnostic agreement and detection of masked hypertension

• Published in: Pregnancy hypertension Vol. 29; pp. 23 - 29
• Main Authors: Nuckols, Virginia R., Stroud, Amy K., Armstrong, Matthew K., Brandt, Debra S., Santillan, Mark K., Santillan, Donna A., Pierce, Gary L.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.08.2022
• Subjects: Ambulatory blood pressure monitoring; Blood Pressure - physiology; Blood Pressure Monitoring, Ambulatory; Female; Home blood pressure monitoring; Humans; Hypertension; Masked hypertension; Masked Hypertension - diagnosis; Postpartum Period; Pre-Eclampsia - diagnosis; Preeclampsia; Home blood pressure monitoring; Preeclampsia; Masked hypertension; Ambulatory blood pressure monitoring
• DOI: 10.1016/j.preghy.2022.05.003
• ISSN: 2210-7789

•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.