The Measurement of Diastolic Blood Pressure During Pregnancy: Which Korotkoff Phase Should be Used?

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OBJECTIVEThe aim of this study was to compare the two Korotkoff phases, to estimate diastolic blood pressure during pregnancy.STUDY DESIGNA cohort of 1194 nulliparous pregnant women were followed up prospectively from the twentieth week of pregnancy until delivery. Blood pressure measurements were obtained with random-zero sphygmomanometers at 20, 23, 25, 27, 31, and 35 weeks and then weekly until delivery. After 10 minutes of rest five blood pressure measurements were obtained in each position: supine, lateral, and seated. Korotkoff phases IV and V were obtained in each measurement.RESULTSThe frequency of 0 values was always <0.5% (n = 10,501 in each time and position). Mean differences between both phases throughout pregnancy fluctuates around 6 mm Hg. Minor differences (mean 3.7 mm Hg) without outlier values were observed in women with diastolic hypertension. Phase 5 showed a better association with other outcome variables related to hypertension, such as proteinuria, intrauterine growth retardation, and hyperuricemia.CONCLUSIONConsidering that phase 5 is easier to obtain, its use implies very few 0 values, that the difference between the two Korotkoff phases is around 6 mm Hg, and that the association with hypertension-related complications is similar to that of phase 4. (AM J OBSTET GYNECOL 1994;170:574-8.)

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