Blood pressure variability during gestation in healthy and complicated pregnancies
Blood pressure variability during gestation in healthy and complicated pregnancies
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DOI：
10.1161/01.hyp.30.3.611
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发表时间：
1997-09-01
期刊：
影响因子：
8.3
通讯作者：
Iglesias, M
中科院分区：
文献类型：
--
作者：
Ayala, DE;Hermida, RC;Iglesias, M
利用动态血压测定仪对血压的可预测性进行评估，并对所获得的时间序列进行适当的处理，可用于妊娠高血压并发症的早期评估。我们使用这种方法来量化临床健康女性以及患有妊娠期高血压或先兆子痫的孕妇在整个怀孕期间的血压和心率的可预测模式。我们分析了71名健康孕妇的503个血压序列和42个患妊娠期高血压或先兆子痫的孕妇的256个血压序列。在第一次产科会诊后每4周监测一次血压(48h)。通过多项式回归分析，建立了正常血压组和高血压组孕妇24小时平均血压随孕期的变化规律。这种方法揭示了24小时平均值随胎龄变化的可预测模式：对于血压正常的孕妇，结果表明，血压在怀孕21周前稳步下降，随后血压在分娩当天上升。这种变化模式在合并妊娠期高血压甚至先兆子痫的孕妇中并不存在：血压的24小时平均值在怀孕第22周之前保持稳定，然后与孕周相关，表明血压在怀孕后半段呈明显的线性上升。对于健康和复杂的妊娠，心率在中期妊娠结束前略有增加，之后保持稳定。这项研究证实并扩展到日常生活中可预测的妊娠相关血压变异性。无并发症妊娠和复杂妊娠之间的差异为早期识别妊娠期高血压和先兆子痫提供了新的终点。
The evaluation of predictable variability in blood pressure by the use of ambulatory devices, and the proper processing of the time series thus obtained, can be useful for the early assessment of hypertensive complications in pregnancy. We have used this approach to quantify a predictable pattern of blood pressure and heart rate throughout pregnancy in clinically healthy women as well as in pregnant women who developed gestational hypertension or preeclampsia. We analyzed 503 blood pressure series from 71 healthy pregnant women and 256 series from 42 women who developed gestational hypertension or preeclampsia. Blood pressure monitoring (48-hour) was done once every 4 weeks after the first obstetric consultation. The pattern of variation along gestation of the 24-hour mean of blood pressure for groups of normotensive and hypertensive pregnant women was established by polynomial regression analysis. This method revealed predictable patterns of variation of 24-hour means with gestational age: for normotensive pregnant women, results indicate a steady decrease in blood pressure up to the 21st week of pregnancy, followed by an increase in blood pressure up to the day of delivery. This pattern of variation is not found in pregnancies complicated with gestational hypertension or even preeclampsia: the 24-hour mean of blood pressure is stable until the 22nd week of pregnancy and then correlated with gestational age, indicating a significant linear increase of blood pressure in the second half of pregnancy. For both healthy and complicated pregnancies, heart rate slightly increases until the end of the second trimester, and it is stable thereafter. This study confirms and extends to ambulatory everyday life conditions the predictable pregnancy-associated variability in blood pressure. The differences between uncomplicated and complicated pregnancies offer new end points for an early identification of gestational hypertension and preeclampsia.