4.5 Article

A multicenter prospective study of home blood pressure measurement (HBPM) during pregnancy in Japanese women

Journal

HYPERTENSION RESEARCH
Volume 45, Issue 10, Pages 1563-1574

Publisher

SPRINGERNATURE
DOI: 10.1038/s41440-022-00992-3

Keywords

Home Blood Pressure; Hypertensive Disorders Of Pregnancy; Individual Variability

Funding

  1. Intramural Research Fund for Cardiovascular Disease of the National Cerebral and Cardiovascular Center [28-4-2]
  2. JSSHP Foundation

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In recent times, home blood pressure monitoring (HBPM) has replaced clinic BP monitoring for diagnosing hypertensive disorders of pregnancy (HDP). A multicenter study was conducted on pregnant Japanese women in the non-high risk group for HDP, where they self-measured and recorded their daily HBP. The study found that HBP was appropriate during the 17-21st weeks of gestation and increased after 24 weeks, returning to non-pregnant levels 4 weeks postpartum. The study also identified cut-off values for HBP during gestation and observed that women who developed HDP had higher systolic and diastolic HBP compared to normal pregnancies.
In the near future, hypertensive disorders of pregnancy (HDP) have been diagnosed by home blood pressure monitoring (HBPM) instead of clinic BP monitoring. A multicenter study of HBPM was performed in pregnant Japanese women in the non-high risk group for HDP. Participants were women (n = 218), uncomplicated pregnancy who self-measured and recorded their HBP daily. Twelve women developed HDP. HBP was appropriate (100 mmHg in systole and 63 mmHg in diastole), bottoming out at 17 to 21 weeks of gestation. It increased after 24 weeks of gestation and returned to non-pregnant levels by 4 weeks of postpartum. The upper limit of normal HBP was defined as the mean value +3 SD for systolic and mean +2 SD for diastolic with reference to the criteria for non-pregnant women. Using the polynomial equation, the hypertensive cut-off of systolic HBP was 125 mmHg at 15 weeks and 132 mmHg at 30 weeks of gestation, while it for diastolic HBP was 79 mmHg at 15 weeks and 81 mmHg at 30 weeks of gestation. Systolic HBP in women who developed HDP was higher after 24 weeks of gestation, and diastolic HBP was higher during most of the pregnancy compared to normal pregnancy. When the variability of individual HBP in women developed HDP compared to normal pregnant women was examined using the coefficient of variation (CV), the CV was lower in HDP before the onset of HDP. HBPM can be used not only for HDP determination, but also for early detection of HDP.

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