PubMed · 11214160
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S S Iyengar. 2001-01-27. Pre-eclampsia.. https://doi.org/10.1016/s0140-6736(05)71760-8
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BACKGROUND: Ambulatory blood pressure measurements may be performed with manual or automatic devices. Such methods seem to be increasingly used for diagnosing conditions like "white coat hypertension" or abnormal variations in the 24-hour blood pressure profile. However, it is not yet known whether these patients are exposed to an increased risk of cardiovascular events. MATERIALS AND METHODS: This paper is a summary of systematic reviews (health technology assessment reports) of the performance and effectiveness of ambulatory blood pressure measurements for the diagnosis of hypertension. RESULTS: Ambulatory blood pressure measurements may be used during medical treatment for hypertension to control blood pressure, and patients using these measurements have been shown to reach the target blood pressure at lower medication levels than patients depending on blood pressure measurements in the surgery. INTERPRETATION: Widespread use of ambulatory blood pressure measurements in order to predict cardiovascular risk requires knowledge about diagnostic and prognostic performance. There are studies that address these concerns, but major weaknesses in study design limit their value. The lack of a consensus on reference values is also an impediment to the use of ambulatory blood pressure measurements.
BACKGROUND: To analyse the evolution of the white coat hypertension (WCH) to sustained hypertension, by means of ambulatory blood pressure monitoring (ABPM) during the first year after its diagnosis. SUBJECTS AND METHOD: A prospective study of cohorts was designed in La Orden Health Center of Huelva, Spain. 86 individuals divided in two groups: a) group not exposed (GNE): 43 voluntary normotensives, and b) group exposed (GE): 43 individuals with WCH, defined as the blood pressure was superior or above 140 and/or 90 mmHg, respectively, with a mean diurnal ABPM below 135 and 85 mmHg in both cases. A ABPM was performed (Spacelabs 90207) at the beginning of the study, after 6 months and after 12 months. The clinical and ambulatory blood pressure and the incidence of sustained hypertension by ABPM in the two groups were compared. Sustained hypertension was considered when the diurnal blood pressure was superior to 135 and/or 85 mmHg for SBP and DBP. RESULTS: At the end of the study, 82 patients were evaluate. The incidence of hypertension at 6 months of follow-up was of 4,76% (CI, 0-26.9) in GNE and 19.04% (95% CI, 0-42,6) in GE (RR: 3.8; 95% CI, 0.86-16.9) (p = 0.052). At one year of follow-up the incidence of hypertension in GNE was of 9.8% (95% CI, 0.31-1) as opposed to 46.3% (95% CI, 20.5-72.1) in GE (RR: 4.63; CI, 1.7-12.4) (p = 0.001). CONCLUSIONS: The patients with WCH present a higher incidence of hypertension as compared to the normotensives, after 12 months of our follow-up.
Pre-eclampsia is usually defined on the basis of new onset hypertension and albuminuria developing after 20 weeks of pregnancy. There are difficulties with measurement of these variables. Conventional sphygmomanometry remains the gold standard for blood-pressure measurement. The value of ambulatory blood-pressure measurement has yet to be established. Oedema is now omitted from all definitions of preeclampsia, although the finding of widespread severe oedema of sudden onset should not be ignored for clinical purposes. Definitions of pre-eclampsia based solely on hypertension and proteinuria ignore the wide clinical variability in this syndrome. Women with no proteinuria but who do have hypertension and other features such as severe headache or other symptoms, thrombocytopenia, hyperuricaemia, disordered liver function, and fetal compromise are likely to have pre-eclampsia. This notion is accepted in the new Australasian definition of pre-eclampsia and more than hinted at in the new American College of Obstetricians and Gynecologists' definition. Definitions used for clinical purposes should be as safe as practical; they are likely to include a considerable number of false positives. Most research studies are weakened if patients without the disease are included. Therefore, a separate stringent research definition of pre-eclampsia we also suggest.