Fang Yiwen, Zuo Lushu, Li Jingge, Shi Huihua, Zhang Ruimin, Han Cha, Lv Lijuan, Zhou Xin
Department of Cardiology, Tianjin Medical University General Hospital, 300052 Tianjin, China.
Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, 300052 Tianjin, China.
Rev Cardiovasc Med. 2025 May 19;26(5):27235. doi: 10.31083/RCM27235. eCollection 2025 May.
Hypertensive disorders of pregnancy (HDP) pose substantial risks to both maternal and fetal health, thereby highlighting the need for precise and comprehensive blood pressure (BP) monitoring methods. Ambulatory blood pressure monitoring (ABPM) offers advantages over traditional office BP measurements by enabling continuous 24-hour assessment, thus capturing circadian BP variations, including nocturnal and morning hypertension, which are often missed when BP is measured in a medical office. This capacity for detailed monitoring allows ABPM to identify specific BP phenotypes, such as normotension, white-coat hypertension, masked hypertension, and sustained hypertension. Each of these phenotypes has unique implications for risk stratification, which helps to identify high-risk pregnancies early and potentially improve outcomes through more targeted interventions. Despite these advantages, three key challenges have limited the widespread adoption of ABPM during pregnancy. First, the complex dynamics in BP variations throughout gestation are influenced by physiological adaptations, such as uterine artery remodeling, which lowers BP before 20 weeks and increases mean arterial pressure after 20 weeks to support fetal growth. Second, adaptive changes in the maternal arterial system alter vascular mechanical properties, complicating accurate BP assessments. Third, diagnostic thresholds specific to pregnancy that are directly linked to adverse pregnancy outcomes are lacking. Therefore, this review addresses the role of ABPM in managing HDP, examining BP dynamics and the suitability of monitoring devices, and ongoing efforts to develop diagnostic thresholds tailored to pregnancy. By exploring these aspects, this review underscores the importance of ABPM in advancing more precise, effective strategies for HDP management and multidisciplinary management programs for pregnant women to enhance clinical decision-making and maternal-fetal outcomes.
妊娠期高血压疾病（HDP）对孕产妇和胎儿健康均构成重大风险，因此凸显了精确且全面的血压（BP）监测方法的必要性。动态血压监测（ABPM）相较于传统诊室血压测量具有优势，它能够进行连续24小时评估，从而捕捉昼夜血压变化，包括夜间高血压和晨起高血压，而这些情况在诊室测量血压时常常被遗漏。这种详细监测的能力使ABPM能够识别特定的血压表型，如血压正常、白大衣高血压、隐匿性高血压和持续性高血压。每种表型对风险分层都有独特的影响，这有助于早期识别高危妊娠，并通过更有针对性的干预措施潜在地改善结局。尽管有这些优势，但三个关键挑战限制了ABPM在孕期的广泛应用。首先，整个孕期血压变化的复杂动态受到生理适应性变化的影响，如子宫动脉重塑，它在孕20周前降低血压，在孕20周后升高平均动脉压以支持胎儿生长。其次，母体动脉系统的适应性变化改变了血管力学特性，使准确的血压评估变得复杂。第三，缺乏与不良妊娠结局直接相关的特定于妊娠的诊断阈值。因此，本综述探讨了ABPM在管理HDP中的作用，研究血压动态变化和监测设备的适用性，以及为制定适合妊娠的诊断阈值所做的持续努力。通过探讨这些方面，本综述强调了ABPM在推进更精确、有效的HDP管理策略以及为孕妇制定多学科管理计划以加强临床决策和改善母婴结局方面的重要性。
