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37. Association of levels of antepartum angiogenic factors with severe postpartum hypertension
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 13 (2018) S50–S150
33. Reliability and agreement of auscultatory and oscillometric blood pressure devices used in pregnancy Emily Aldridge, Jose Mollen, Petra Verburg, Melanie Wittwer, Claire Roberts, Margaret Arstall, Gustaaf Dekker (Australia) Introduction: Accurate blood pressure (BP) measurements are vital in the detection of hypertensive disorders of pregnancy, such as gestational hypertension and preeclampsia. In South Australia, the manual technique remains the gold standard of measuring BP in the antenatal clinic, but may be inferior to sophisticated automated devices. Objective: The objective of this study was to compare the manual technique with three automated oscillometric BP devices (Microlife Vital Signs Alert (MVSA) [Microlife, Taipei, Taiwan], Arteriograph [Tensiomed, Budapest, Hungary] and Uscom BP+ [USCOM, Sydney, Australia]) in a pregnant population. Methods: This prospective study recruited 200 pregnant women at any stage of gestation between June and August 2017. Manual BP was measured first to prevent observer bias, followed by two measurements per device in a randomised order. Intra- and intertechnique reliability between repeated measurements was assessed with Intraclass Correlation Coefficients. Bland–Altman analyses evaluated the level of agreement between each variable. Techniques were graded according to British Hypertension Society (BHS) and Association for the Advancement of Medical Instrumentation (AAMI) criteria. Results: Intra- and inter-technique reliability was excellent for all four techniques (all ICC >0.80). According to our pre-defined levels of agreement for mean systolic BP, MSVA and Uscom BP+ (mean difference <5 mmHg), but not Arteriograph (mean difference 8 mmHg), demonstrated good agreement with the manual technique. There was acceptable agreement for mean diastolic BP measurements for manual versus the three other techniques. Manual technique, MVSA and Uscom BP+, but not Arteriograph, fulfilled BHS and AAMI criteria. Conclusion: Although each technique demonstrated excellent intra- and inter-device reliability, only MVSA and Uscom BP+ reached an acceptable clinical level of agreement with manual technique, and also fulfilled the BHS and AAMI criteria. Arteriograph consistently read higher systolic BP readings, indicating it may be unsuitable for use in an antenatal clinic setting. doi:10.1016/j.preghy.2018.08.174
36. Angiogenic factors and preeclampsia with severe features among a primarily African American cohort with hypertensive disorders of pregnancy Ruby Minhas, Joana Lopes Perdigao, Sireesha Chintala, Ariel Mueller, Siaw Li Chan, Tet-Kin Yeo, Sarosh Rana (University of Chicago Medicine, Chicago, United States) Introduction: Preeclampsia related morbidity and mortality is rising predominantly due to delayed identification of patients at risk for severe features (preE-SF). This study explored the association between angiogenic markers (soluble fms-like tyrosine kinase-1 [sFlt] and placental growth factor [PlGF]) and preE-SF. Methods: Women with hypertensive disorders of pregnancy (HDP) were enrolled upon admission. Blood samples were collected within 96 h prior to delivery. Angiogenic markers were measured on an automated platform. Severe disease was defined by ACOG criteria as BP P160/110, thrombocytopenia, right upper quadrant pain/epigastric pain/transaminases, renal insufficiency, pulmonary edema, or cerebral/visual disturbances. Descriptive statistics were generated and assessed with a Wilcoxon Rank Sum, chi-square or Fisher’s exact test, as appropriate. Univariate and multivariable logistic regression
S59
was used to assess for differences in outcomes and angiogenic markers were assessed in tertiles. Results: Our study included 375 women with HDP, of which 127 (33.9%) had preE-SF, 115 (30.7%) had gestational hypertension, and 66 (17.6%) had chronic hypertension. Our cohort was predominantly African American (74.4%). Fig. 1 outlines the prevalence of severe features among those with severe disease. Levels of sFlt1 (pg/ml) were significantly higher in women with severe features compared to those without (9372.5 vs. 3607.0; p < 0.0001), while levels of PlGF (pg/ml) were lower (51.0 vs. 122.0; p < 0.0001) and the ratio of sFlt1/PlGF was significantly higher (212.0 vs. 32.0, p < 0.0001). The highest tertile of sFlt1/PlGF was strongly associated with preESF (OR 9.05, 95% CI: 4.25–19.24; p < 0.0001) in multivariable analysis. Conclusion: This study demonstrates a significant association between an abnormal angiogenic profile and preE-SF in a primarily African American cohort. Additional evaluation of the role of angiogenic markers during assessment for HDP and disease severity is needed. doi:10.1016/j.preghy.2018.08.175
37. Association of levels of antepartum angiogenic factors with severe postpartum hypertension Ruby Minhas, Joana Lopes Perdigao, Sireesha Chintala, Ariel Mueller, Siaw Li Chan, Tet-Kin Yeo, Sarosh Rana (University of Chicago Medicine, Chicago, United States) Introduction: Postpartum hypertension (PPHTN) often arises from an existing hypertensive disorder of pregnancy (HDP). Limited data exists about antecedent presentation and risk factors of PPHTN, especially among high risk groups such as African American (AA) women. We studied the association between levels of antepartum angiogenic biomarkers (soluble fms-like tyrosine kinase-1 [sFlt1] and placental growth factor [PlGF]) and risk of severe PPHTN among predominantly AA women. Methods: Women with HDP were enrolled upon admission and blood was collected within 96 h of delivery. sFlt1 and PlGF were measured on an automated platform. PPHTN was defined as severe if systolic blood pressures (SBP) was P160 or diastolic blood pressure (DBP) P110 and mild if SBP P140 or DBP P90. Descriptive statistics are reported and assessed with a Wilcoxon Rank Sum or chi-square test, as appropriate. Univariate and multivariable logistic regression was used to assess the association between PPHTN and angiogenic factors, reporting the area under the receiver operating curve (AUC). Results: A total of 375 women were enrolled, with 279 (74.4%) AA and 151 (40.3%) who met criteria for severe PPHTN. About half (52.9%) of women with severe PPHTN also had pre-eclampsia with severe features prior to delivery. The sFlt1/PlGF ratio was significantly higher for both severe and mild PPHTN compared to women with normal postpartum BPs (73.5, 46.0 and 13.0 respectively, p-values < 0.0001). Furthermore, the highest tertile of antepartum sFlt1/PlGF ratio was associated with severe PPHTN [OR 2.52, 95% CI: 1.49–4.27; p = 0.001] which persisted after adjustment of confounders [OR 2.83; p = 0.001]. When predicting severe PPHTN, the adjusted AUC for sFlt1/PlGF was 0.71. Conclusion: Severe PPHTN is frequent in women presenting with antepartum HDP in this patient population. There is a significant association between antepartum angiogenic biomarkers and severe PPHTN. Further studies need to evaluate the mechanisms of such association. doi:10.1016/j.preghy.2018.08.176
33. Reliability and agreement of auscultatory and oscillometric blood pressure devices used in pregnancy Emily Aldridge, Jose Mollen, Petra Verburg, Melanie Wittwer, Claire Roberts, Margaret Arstall, Gustaaf Dekker (Australia) Introduction: Accurate blood pressure (BP) measurements are vital in the detection of hypertensive disorders of pregnancy, such as gestational hypertension and preeclampsia. In South Australia, the manual technique remains the gold standard of measuring BP in the antenatal clinic, but may be inferior to sophisticated automated devices. Objective: The objective of this study was to compare the manual technique with three automated oscillometric BP devices (Microlife Vital Signs Alert (MVSA) [Microlife, Taipei, Taiwan], Arteriograph [Tensiomed, Budapest, Hungary] and Uscom BP+ [USCOM, Sydney, Australia]) in a pregnant population. Methods: This prospective study recruited 200 pregnant women at any stage of gestation between June and August 2017. Manual BP was measured first to prevent observer bias, followed by two measurements per device in a randomised order. Intra- and intertechnique reliability between repeated measurements was assessed with Intraclass Correlation Coefficients. Bland–Altman analyses evaluated the level of agreement between each variable. Techniques were graded according to British Hypertension Society (BHS) and Association for the Advancement of Medical Instrumentation (AAMI) criteria. Results: Intra- and inter-technique reliability was excellent for all four techniques (all ICC >0.80). According to our pre-defined levels of agreement for mean systolic BP, MSVA and Uscom BP+ (mean difference <5 mmHg), but not Arteriograph (mean difference 8 mmHg), demonstrated good agreement with the manual technique. There was acceptable agreement for mean diastolic BP measurements for manual versus the three other techniques. Manual technique, MVSA and Uscom BP+, but not Arteriograph, fulfilled BHS and AAMI criteria. Conclusion: Although each technique demonstrated excellent intra- and inter-device reliability, only MVSA and Uscom BP+ reached an acceptable clinical level of agreement with manual technique, and also fulfilled the BHS and AAMI criteria. Arteriograph consistently read higher systolic BP readings, indicating it may be unsuitable for use in an antenatal clinic setting. doi:10.1016/j.preghy.2018.08.174
36. Angiogenic factors and preeclampsia with severe features among a primarily African American cohort with hypertensive disorders of pregnancy Ruby Minhas, Joana Lopes Perdigao, Sireesha Chintala, Ariel Mueller, Siaw Li Chan, Tet-Kin Yeo, Sarosh Rana (University of Chicago Medicine, Chicago, United States) Introduction: Preeclampsia related morbidity and mortality is rising predominantly due to delayed identification of patients at risk for severe features (preE-SF). This study explored the association between angiogenic markers (soluble fms-like tyrosine kinase-1 [sFlt] and placental growth factor [PlGF]) and preE-SF. Methods: Women with hypertensive disorders of pregnancy (HDP) were enrolled upon admission. Blood samples were collected within 96 h prior to delivery. Angiogenic markers were measured on an automated platform. Severe disease was defined by ACOG criteria as BP P160/110, thrombocytopenia, right upper quadrant pain/epigastric pain/transaminases, renal insufficiency, pulmonary edema, or cerebral/visual disturbances. Descriptive statistics were generated and assessed with a Wilcoxon Rank Sum, chi-square or Fisher’s exact test, as appropriate. Univariate and multivariable logistic regression
S59
was used to assess for differences in outcomes and angiogenic markers were assessed in tertiles. Results: Our study included 375 women with HDP, of which 127 (33.9%) had preE-SF, 115 (30.7%) had gestational hypertension, and 66 (17.6%) had chronic hypertension. Our cohort was predominantly African American (74.4%). Fig. 1 outlines the prevalence of severe features among those with severe disease. Levels of sFlt1 (pg/ml) were significantly higher in women with severe features compared to those without (9372.5 vs. 3607.0; p < 0.0001), while levels of PlGF (pg/ml) were lower (51.0 vs. 122.0; p < 0.0001) and the ratio of sFlt1/PlGF was significantly higher (212.0 vs. 32.0, p < 0.0001). The highest tertile of sFlt1/PlGF was strongly associated with preESF (OR 9.05, 95% CI: 4.25–19.24; p < 0.0001) in multivariable analysis. Conclusion: This study demonstrates a significant association between an abnormal angiogenic profile and preE-SF in a primarily African American cohort. Additional evaluation of the role of angiogenic markers during assessment for HDP and disease severity is needed. doi:10.1016/j.preghy.2018.08.175
37. Association of levels of antepartum angiogenic factors with severe postpartum hypertension Ruby Minhas, Joana Lopes Perdigao, Sireesha Chintala, Ariel Mueller, Siaw Li Chan, Tet-Kin Yeo, Sarosh Rana (University of Chicago Medicine, Chicago, United States) Introduction: Postpartum hypertension (PPHTN) often arises from an existing hypertensive disorder of pregnancy (HDP). Limited data exists about antecedent presentation and risk factors of PPHTN, especially among high risk groups such as African American (AA) women. We studied the association between levels of antepartum angiogenic biomarkers (soluble fms-like tyrosine kinase-1 [sFlt1] and placental growth factor [PlGF]) and risk of severe PPHTN among predominantly AA women. Methods: Women with HDP were enrolled upon admission and blood was collected within 96 h of delivery. sFlt1 and PlGF were measured on an automated platform. PPHTN was defined as severe if systolic blood pressures (SBP) was P160 or diastolic blood pressure (DBP) P110 and mild if SBP P140 or DBP P90. Descriptive statistics are reported and assessed with a Wilcoxon Rank Sum or chi-square test, as appropriate. Univariate and multivariable logistic regression was used to assess the association between PPHTN and angiogenic factors, reporting the area under the receiver operating curve (AUC). Results: A total of 375 women were enrolled, with 279 (74.4%) AA and 151 (40.3%) who met criteria for severe PPHTN. About half (52.9%) of women with severe PPHTN also had pre-eclampsia with severe features prior to delivery. The sFlt1/PlGF ratio was significantly higher for both severe and mild PPHTN compared to women with normal postpartum BPs (73.5, 46.0 and 13.0 respectively, p-values < 0.0001). Furthermore, the highest tertile of antepartum sFlt1/PlGF ratio was associated with severe PPHTN [OR 2.52, 95% CI: 1.49–4.27; p = 0.001] which persisted after adjustment of confounders [OR 2.83; p = 0.001]. When predicting severe PPHTN, the adjusted AUC for sFlt1/PlGF was 0.71. Conclusion: Severe PPHTN is frequent in women presenting with antepartum HDP in this patient population. There is a significant association between antepartum angiogenic biomarkers and severe PPHTN. Further studies need to evaluate the mechanisms of such association. doi:10.1016/j.preghy.2018.08.176