Hermida Ramón C, Ayala Diana E, Fernández José R, Mojón Artemio, Iglesias Manuel
Bioengineering and Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo, 36200, Spain.
J Hypertens. 2004 Mar;22(3):565-72. doi: 10.1097/00004872-200403000-00020.
The tolerance-hyperbaric test has been shown to provide a valuable approach for the prediction of the outcome of pregnancy. In this test, diagnosis of hypertension is based on the hyperbaric index (area of blood pressure excess above the upper limit of a reference threshold) calculated by comparison with a time-specified tolerance interval for the circadian variability of blood pressure.
To evaluate prospectively the stability and reproducibility of the tolerance-hyperbaric test.
We studied 403 women who provided 2430 blood pressure series sampled for 48 consecutive hours once every 4 weeks from the first obstetric visit (mostly within the first trimester of gestation) until delivery. Circadian 90% tolerance limits for blood pressure were established as a function of trimester of gestation from 497 series previously sampled from an independent reference group of 189 normotensive pregnant women. Diagnosis of hypertension was established in this trial for each woman in the validation sample on the highly restricted basis of presenting at least one blood pressure profile with a hyperbaric index above the threshold for diagnosis after 20 weeks of gestation.
Sensitivity of the tolerance-hyperbaric test was 93% for women sampled during the first trimester of gestation, and increased to 99% by the third trimester. Specificity was more than 99% in all trimesters. The positive and negative predictive values were greater than 96% in all trimesters.
The tolerance-hyperbaric test represents a reproducible, stable, non-invasive and high-sensitivity test for the very early identification of subsequent hypertension in pregnancy.
耐受性高压试验已被证明是预测妊娠结局的一种有价值的方法。在该试验中，高血压的诊断基于通过与血压昼夜变化的时间指定耐受区间进行比较而计算出的高压指数（血压超过参考阈值上限的区域）。
前瞻性评估耐受性高压试验的稳定性和可重复性。
我们研究了403名女性，她们从首次产科就诊（大多在妊娠早期）到分娩，每4周连续48小时采样一次，共提供了2430个血压序列。根据之前从189名血压正常的孕妇独立参考组中采样的497个序列，确定了不同妊娠阶段血压的昼夜90%耐受极限。在本试验中，验证样本中的每位女性，若在妊娠20周后至少有一次血压曲线的高压指数高于诊断阈值，就在高度严格的基础上确诊为高血压。
妊娠早期采样的女性中，耐受性高压试验的敏感性为93%，到妊娠晚期增至99%。所有妊娠阶段的特异性均超过99%。所有妊娠阶段的阳性和阴性预测值均大于96%。
耐受性高压试验是一种可重复、稳定、无创且高灵敏度的试验，可用于极早期识别妊娠后期的高血压。
