Rath Werner, Tsikouras Panagiotis, Schlembach Dietmar
Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel.
Department of Obstetrics and Gynecology, Democritus University of Thrace, Komotini, Greece.
Z Geburtshilfe Neonatol. 2020 Dec;224(6):333-338. doi: 10.1055/a-1266-7401. Epub 2020 Dec 4.
The prevalence of hypertensive disorders in pregnancy (HDP) is 6-8%. Blood pressure measurement (BPM) remains the cornerstone of diagnosis and should be performed in a standardised manner using automated devices. Office BPM represents only a spotty reading in an "artificial" environment failing to diagnose white coat hypertension (WCH). Ambulatory and home blood pressure measurement (ABPM/HBPM) are recommended for the diagnosis and differentiation of hypertension as well as for blood pressure and therapy control in women with HDP. Patient compliance is crucial for the use of both methods. ABPM is an appropriate method for the early identification of WCH and masked hypertension as well as for differentiating WCH from chronic hypertension < 20 week's gestation. HBPM has been shown to reduce the number of antenatal visits and hospital admissions compared to office blood pressure measurement without compromising maternal and fetal outcomes; it also avoids unnecessary antihypertensive medications and reduces the rate of labour inductions and false diagnosis of "preeclampsia". Problems associated with ABPM are its limited availability and inconvenience to patients due to sleep disturbances. Disadvantages of HBPM are the need for patient training, potential measurement errors, and the lack of evidence-based BP thresholds. The widespread use especially of HBPM may contribute to a reduction in workload of obstetric staff in the hospital and may save hospital expense.
妊娠期高血压疾病（HDP）的患病率为6%-8%。血压测量（BPM）仍然是诊断的基石，应使用自动设备以标准化方式进行。诊室血压测量仅在“人工”环境中提供零散读数，无法诊断白大衣高血压（WCH）。推荐使用动态血压监测和家庭血压测量（ABPM/HBPM）来诊断和鉴别高血压，以及用于HDP女性的血压和治疗控制。患者的依从性对于这两种方法的使用至关重要。ABPM是早期识别WCH和隐匿性高血压以及区分WCH与妊娠<20周慢性高血压的合适方法。与诊室血压测量相比，HBPM已被证明可减少产前检查次数和住院次数且不影响母婴结局；它还可避免不必要的降压药物使用，并降低引产率和“子痫前期”的误诊率。与ABPM相关的问题是其可用性有限，且因睡眠干扰给患者带来不便。HBPM的缺点是需要对患者进行培训、存在潜在测量误差以及缺乏基于证据的血压阈值。尤其是HBPM的广泛使用可能有助于减轻医院产科工作人员的工作量，并可能节省医院费用。
