[PP.24.09] ABPM AS A PREDICTOR OF EVENT IN PREGNANCY: VALUE OF THE PATTERN OF NIGHT DROP OF BLOOD PRESSURE AND THE VALUES OF THE DIASTOLIC ARTERIAL PRESSURE

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Abstract

Objective:

It is still not well known the prognostic cardiovascular (CV) value of 24 h ambulatory blood pressure monitoring (ABPM) in the pregnant woman with hipertension (HT).

Objective:

The authors intended to assess the prognostic value of ABPM, in pregnant women with HT in predicting maternofetal event during pregnancy.

Design and method:

Prospective and observational study which included 139 pregnant women designed from the Obstetrics appointment to the HT appointment, having done the ABPM, between January 2007 and June 2015. The follow-up occured until the child-birth (262 ± 28 days). The definied events were: mother, fetal or neonatal dead, pre-eclampsia, eclampsia, gestational diabetes, prematurity and fetal growth restriction.

Results:

The study included 139 pregnant women with the age of 32 ± 6 years, 58% with cronic HT, 42% with gestacional HT. In the follow-up, were detected 71 events. About the parameters of the ABPM, the Systolic Blood Pressure dipping (SBP) verified: 87 with Dipper (D) pattern and 51 with non-Dipper (ND) pattern. Comparing pattern D vs ND, the D pattern had statisticaly significant reduction of the events (X2, p < 0,017). In the analysis of curves survivor of Kaplan-Meier free of events, the ND patter was associated with worst curves of survivor free of events (log rank 6.22, p < 0,01). In a multivariate Cox analysis adjusted for potential confounders (age, obstetric, personal and family history, body mass index) 24 h diastolic blood pressure (DBP), 24 h SBP and night DBP were predictive of maternofetal events, respectivelly (Hazzard ratio 1.03, (95% CI 1.00–1.05; p < 0.02); HR 1.03, (95% CI 1.01–1.06; p < 0,02); HR 1.04, (95% CI 1.01 -1.07; p < 0,01)), specially the night DBP.

Conclusions:

In our sample the ABPM found that SBP dipping and night DBP were predictive of events in puerperal, pregnancy and newborn, mainly the night DBP dippping.

Conclusions:

The authors consider that ABPM is a tool for pregnant with HT, because this is one method available that analyzes the night blood pressure which seems to be the most important.

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