Introduction:
One-third of women with a history of preeclampsia (hxPE), a hypertensive pregnancy disorder, develop chronic hypertension (HTN) within five years postpartum. Twenty-four hour ambulatory blood pressure monitoring (ABPM) shows that 12% of women with hxPE have ‘masked’ HTN. Masked HTN is undetected in routine clinical assessment but is associated with elevated cardiovascular disease risk. ABPM (gold-standard) or home blood pressure monitoring (HBPM) is needed to identify masked HTN. HBPM is a well-tolerated, inexpensive alternative to ABPM. However, the ability of HBPM to detect masked postpartum HTN using new AHA/ACC HTN guidelines is unknown. The purpose of this study was to compare ABPM and HBPM in the identification of masked and sustained HTN among young women with hxPE and healthy pregnancy (HP) controls 1-3 years postpartum.
Methods:
Women with hxPE (N=22; age 33 ± 5 yrs) and HP controls (N=26; age 34 ± 4 yrs) were assessed 18 ± 6 months postpartum. Seated office blood pressure (BP) was collected with an automated brachial cuff and averaged over three trials. ABPM (Mobil-o-graph) was conducted with a portable, automated brachial cuff and averaged over 38 ± 2 awake and asleep BP recordings. Participants completed HBPM (Microlife) morning and evening for seven consecutive days. BP thresholds for HTN were determined according to 2017 AHA/ACC clinical guidelines.
Results:
HTN was more prevalent among women with hxPE compared with HP assessed by office BP (59 vs. 15 %, P=0.002) and ABPM (68 vs. 31 %, P=0.01) but not HBPM (41 vs 19 %, P=0.10). The prevalence of masked HTN did not differ between women with hxPE and HP (14 vs. 19%, P=0.71) assessed by ABPM. In the entire cohort, HBPM detected 50% of masked HTN cases identified by ABPM. HBPM agreed with ABPM on HTN status (κ = 0.49, P=0.002). HBPM and ABPM detected uncontrolled HTN in three of four women with hxPE prescribed anti-hypertensive medication.
Conclusion:
HxPE is associated with a higher prevalence of HTN 1-3 yrs postpartum compared with controls, but the prevalence of masked HTN did not differ. ABPM and HBPM showed concordant classification of HTN using current BP guidelines. These findings indicate that HBPM may be a valuable pre-screening tool for early identification and management of HTN postpartum.
Prevalence and Predictors of Masked Hypertension Detected by Home Blood Pressure Monitoring in Children and Adolescents: The Arsakeion School Study