Salazar Martin R, Espeche Walter G, Leiva Sisnieguez Betty C, Balbín Eduardo, Leiva Sisnieguez Carlos E, Stavile Rodolfo N, March Carlos E, Grassi Florencia, Santillan Claudia, Cor Susana, Carbajal Horacio A
aHospital Universitario Gral. San Martín bFacultad de Ciencias Médicas, UNLP, La Plata, Argentina.
J Hypertens. 2016 Nov;34(11):2248-52. doi: 10.1097/HJH.0000000000001067.
The aim was to evaluate the prevalence of nocturnal and masked hypertension and the prognostic values of these blood pressure (BP) abnormalities in normotensive women coursing a high-risk pregnancy.
The study was performed in pregnant women with 20 or more weeks of gestation coursing a high-risk pregnancy, sent to a specialized hypertension department to perform a prospective defined protocol of BP evaluation. Women with office BP at least 140/90 mmHg were excluded. An ambulatory monitoring of BP was performed to identify masked and nocturnal hypertension (defined according to the current guidelines). The adjusted risk for development of preeclampsia/eclampsia (PEEC) was estimated using logistic regression. The ability of SBP and DBP to identify risk of PEEC was estimated using area under the receiver-operating characteristic curves.
Eighty-seven women (29 ± 7 years old, 30 ± 5 weeks of pregnancy) were included in this analysis. The prevalence of masked hypertension was 33.3%. Nocturnal hypertension was found in 42.5% of the women. Remarkably, 27.0% of the women with nocturnal hypertension had normal 24-h values according to ambulatory BP monitoring. Twenty-two patients developed PEEC; adjusted relative risks increased with the presence of nocturnal (odds ratio = 4.72, 95% confidence interval 1.25-19.43, P = 0.023) or masked hypertension (odds ratio = 7.81, 95% confidence interval 2.6-22.86, P = 0.001). Nocturnal SBP and DBP had the highest abilities to predict PEEC (area under the curve = 0.77 and 0.80, respectively).
Masked and nocturnal hypertension are frequent findings in normotensive women coursing a high-risk pregnancy, and their presence implies an increased risk to develop PEEC.
评估夜间高血压和隐蔽性高血压的患病率，以及这些血压异常情况在患有高危妊娠的血压正常女性中的预后价值。
该研究针对妊娠20周及以上的高危妊娠孕妇开展，这些孕妇被送往专门的高血压科室，按照前瞻性定义的方案进行血压评估。排除诊室血压至少为140/90 mmHg的女性。通过动态血压监测来识别隐蔽性高血压和夜间高血压（根据现行指南定义）。使用逻辑回归估计发生先兆子痫/子痫（PEEC）的调整风险。使用受试者工作特征曲线下面积来估计收缩压和舒张压识别PEEC风险的能力。
本分析纳入了87名女性（年龄29±7岁，妊娠30±5周）。隐蔽性高血压的患病率为33.3%。42.5%的女性存在夜间高血压。值得注意的是，根据动态血压监测，27.0%的夜间高血压女性24小时血压值正常。22名患者发生了PEEC；夜间高血压（比值比=4.72，95%置信区间1.25-19.43，P=0.023）或隐蔽性高血压（比值比=7.81，95%置信区间2.6-22.86，P=0.001）的存在使调整后的相对风险增加。夜间收缩压和舒张压预测PEEC的能力最强（曲线下面积分别为0.77和0.80）。
在患有高危妊娠的血压正常女性中，隐蔽性高血压和夜间高血压很常见，它们的存在意味着发生PEEC的风险增加。
