Impaired circadian rhythm of blood pressure predicting adverse events in preeclampsia


  • Nitisha Vijayvargia Department of Obstetrics and Gynecology, JLN Medical College, Ajmer, Rajasthan
  • Meenakshi Samariya Department of Obstetrics and Gynecology, JLN Medical College, Ajmer, Rajasthan



Nocturnal diastolic blood pressure, Reverse dipping pattern, Non-dipping pattern


Background: Physiologically Blood pressure is higher during the day time (between 09 AM to 6 PM) and lower at night (10 pm to 3:00 am). During night both systolic and diastolic blood pressure readings drop by about 10-20%. In preeclampsia, the nocturnal decrease of BP is blunted and there is less variation among BP circadian values. Objective of the study is to know whether ratio of morning and nocturnal mean diastolic blood pressures calculated by timed i.e., 6 hourly blood pressure monitoring could be used to predict the prognosis of preeclampsia as in terms of Maternal and fetal prognosis.

Methods: A prospective study is done using 6 hourly blood pressure measurements of antenatal patients in third trimester admitted for gestational hypertension or preeclampsia and their observation till delivery was done.
Results: It is observed that non dipping and increased nocturnal diastolic blood pressures pattern causing reverse dipping pattern are significantly associated with increased severity of disease (p=000).
Both maternal (p=0.04) and fetal adverse event (p=0.004) increased significantly with blunting of decrease in nocturnal blood pressures.

Conclusions: We thus can conclude that blunting/reversal of circadian rhythm of blood pressure indicates progress of disease to its more severe form. It thus could be of great help in deciding for monitoring, timing of antihypertensives and prophylactic medications and deciding for termination of gestation.

Author Biographies

Nitisha Vijayvargia, Department of Obstetrics and Gynecology, JLN Medical College, Ajmer, Rajasthan

Senior resident at Department of obstetrics and gynaecology

J.L.N. Medical College Ajmer. Rajasthan , India

Meenakshi Samariya, Department of Obstetrics and Gynecology, JLN Medical College, Ajmer, Rajasthan

Associate Professor at department of obstetrics and Gynaecology


ACOG Task force on hypertension in pregnancy. Obstetrics: Hypertension pregnancy induced practice guidelines, February 2013. Obstet Gynecol. 2013;15-19.

Prabha GH, Singh RK, Urmila S, Seema M, Verma NS, Neelam B. Circadian Pattern of Blood Pressure in Normal Pregnancy and Preeclampsia. J Obstetr Gynecol India. 2011;61(4):413-7.

Sawyer MM, Lipshitz J, Anderson GD, Dilts PV Jr, Halperin L. Diurnal and short-term variation of blood pressure: comparison of preeclamptic, chronic hypertensive, and normotensive patients. Obstet Gynecol. 1981;58(3):291-6.

Halligan A, Shennan A, Lambert PC, De Swiet M, Taylor DJ. Diurnal blood pressure difference in the assessment of preeclampsia. Obstet Gynaecol. 1996;87:205-8.

Benedetto C, Zonca M, Marozio L, Dolci C, Carandente F, Massobrio M. Blood pressure pattern in normal pregnancy and in pregnancy induced hypertension. Preeclampsia and chronic hypertension. Obstet Gynaecol. 1996;88(4, Part I):503-10.

Correia A, Vidal S, Alexandra C, Leitão F. Value of ambulatory blood pressure measure in pregnancy hypertension. Clin J Obstet Gynecol. 2018;1:067-72.

Nobre F, Mion Junior D. Ambulatory Blood pressure monitoring: Five decades of more light and less shadows. Arq Bras Cardiol 2016;106:528-37.

Ayala DE, Ucieda R, Hermida RC. Chrono therapy with low dose aspirin for prevention of complications in pregnancy. Chronobiol Int. 2013;30:260-79.

Maynard SE, Karumanchi SA. Angiogenic factors and preeclampsia. Semin Nephrol. 2011;31:33-46.

Beilin LJ, Deacon J, Michael CA, Vandongen R, Lalor CM, Barden AE et al. Diurnal rhythms of blood pressure, plasma renin activity, angiotensinII and catecholamines in normotensive and hypertensive pregnancies. Clin Exp Hypertens. B 1983;2:271-93.






Original Research Articles