Prevalence of white coat hypertension amongst pregnant women admitted with high BP recordings in ante-natal clinic

Authors

  • Sandeep Sood Department of Obstetrics and Gynecology, Command Hospital, Lucknow, Uttar Pradesh, India
  • Kuldeep Kumar Ashta Department of Internal Medicine, Base Hospital, Delhi Cantt, Delhi, India
  • Sirisha Anne Department of Obstetrics and Gynecology, Command Hospital, Lucknow, Uttar Pradesh, India
  • Ravi Kumar Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20194836

Keywords:

Ante-natal clinic, Essential hypertension, Pregnancy, Pre-eclampsia, White coat hypertension

Abstract

Background: White coat hypertension (WCH) is a common and well recognized phenomenon with significant prevalence amongst all age groups. This is also quite prevalent in the pregnant women with an intermediate long term prognosis between hypertensive and normo-tensive individuals. It is important to assess the true prevalence WCH in pregnant women and to prevent unnecessary medications to them during pregnancy but at the same time to keep a timely follow up and a watchful eye on these patients to identify complications at the earliest. Study was conducted at a peripheral secondary level hospital with a small obstetrics and gynecology OPD and ward. 54 patients were diagnosed to be hypertensive in Antenatal Clinic.

Methods: All pregnant women who presented to the ANC were screened for hypertension. Those who were diagnosed to be hypertensive in antenatal clinic and these patients were then admitted for Ambulatory Blood Pressure Monitoring (ABPM) for 24 hours.

Results: The ABPM tracings were checked and tabulated to arrive at the final diagnosis after 24 hrs. The prevalence of ‘WCH’ in this study was 48.15% as 26/54 patients were found to have their average BP < 140/90 mmHg after measurement by ABPM over 24 hours so they were diagnosed as ‘White Coat Hypertension’ patients.

Conclusions: Many women who come to ANC in the early pregnancy are diagnosed to have hypertension. WCH is a well known phenomenon in pregnancy. WCH must be ruled out prior to starting these patients on anti-hypertensive medications.

References

Brown MA, Davis GK. Hypertension in pregnancy. In: Mancia G, Chalmers J, Julius S, et al, editors. Manual of Hypertension. London: Churchill Livingstone. 2002;579-598.

Higgins JR, Swiet M. Blood-pressure measurement and classification in pregnancy. Lancet. 2001;357:131-5.

Duley L. The global impact of pre-eclampsia and eclampsia. Semin. Perinatol. 2009;33:130-7.

Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ. 2005;330:565.

Cnattingius S, Reilly M, Pawitan Y, Lichtenstein P. Maternal and fetal genetic factors account for most of familial aggregation of preeclampsia: a population-based Swedish cohort study. Am J Med Genet. 2004;130:365-71.

Díaz HS, Toh S, Cnattingius S. Risk of pre-eclampsiain first and subsequent pregnancies: prospective cohort study. BMJ. 2009;338:2255.

Pettit F, Mangos G, Davis G, Henry A, Brown MA. Pre-ecclampsia causes adverse maternal outcomes across the gestational spectrum. Pregnancy Hypertension. 2015 April;5(2):198-204.

Chesley LC, Sibai BM. Clinical significance of elevated mean arterial pressure in the second trimester. Am J Obstet Gynecol. 1988;159:275-9.

Miller RS, Rudra CB, Williams MA. First-trimester mean arterial pressure and risk of preeclampsia. Am J Hypertens. 2007;20:573-8.

Franklin E. White-coat hypertension: new insights from recent studies. Am Heart Asso J. 2013;15:982-6.

Shahbazian N, Shahbazian H, Mohammadjafari R, Mousavi M. Ambulatory monitoring of blood pressure and pregnancy outcome in pregnant women with white coat hypertension in the third trimester of pregnancy. J Nephropharmacol. 2013;2(1):5-9.

Brown MA, Mangos G, Greg D, Homer C. The natural history of white coat hypertension during pregnancy. Int J Obst Gynaecol. 2005;112:601-6.

Moutquin JM, Rainville C, Giroux L, Raynauld P, Amyot G, Bilodeau R, Pelland N. A prospective study of blood pressure in pregnancy: prediction of preeclampsia. Am J Obstet Gynecol. 1985;151:191-6.

Halberg E, Delmore P, Finch M, Cornélissen G, Halberg F. Chronobiologic assessment of deviant human blood pressure: an invitation for improvements. In Hayes DK, Pauly JE, Reiter RJ (eds.). Chronobiology: its role in clinical medicine, general biology, and agriculture, part A. New York: Wiley-Liss. 1990:305-318.

Patterson HR. Sources of error in recording the blood pressure of patients with hypertension in general practice. BMJ. 1984;289:1661-4.

Ayala DE, Hermida RC, Mojón A, Fernández JR, Iglesias M. Circadian blood pressure variability in healthy and complicated pregnancies. Hypertension. 1997;30:603-10.

Page EW, Christianson R. The impact of mean arterial pressure in the middle trimester upon the outcome of pregnancy. Am J Obstet Gynecol. 1976;125:740-6.

Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from The International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens. Pregnancy. 2001;20:x-xiv.

Fabbian F, Smolensky MH, Tiseo R, Pala M, Manfredini R, Portaluppi F. Dipper and non-dipper blood pressure 24 hour patterns: Circadian rhythm - dependent physiologic and pathophysiologic mechanisms. Chronobiol Int. 2012;29.

Hermida RC, Ayala DE, Fernández JR, Mojón A, Alonso I, Calvo C. Modeling the circadian variability of ambulatorily monitored blood pressure by multiple-component analysis. Chronobiol Int. 2002;19:461-81.

Contard S, Chanudet X, Coisne D, Battistella P, Marichal JF, Pitiot M, et al. Ambulatory monitoring of blood pressure in normal pregnancy. Am J Hypertens. 1993;6:880-4.

Halligan A, O’Brien E, O’Malley K, Mee F, Atkins N, Conroy R, Walshe JJ, Darling M. Twenty-four-hour ambulatory blood pressure measurement in a primigravid population. J Hypertens. 1993;11:869-73.

Hermida RC, Ayala DE, Mojón A, Fernández JR. Time-qualified reference values for ambulatory blood pressure monitoring in pregnancy. Hypertension. 2001;38:746-52.

Bellomo G, Narducci PL, Rondoni F, Pastorelli G, Stangoni G, Angeli G. Prognostic value of 24-hour blood pressure in pregnancy. JAMA. 1999;282:1447-52.

Downloads

Published

2019-10-23

Issue

Section

Original Research Articles