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Conditions influencing blood pressures in healthy gravidas
International Journal of Gynecology & Obstetrics 68 Ž2000. 45᎐46
Brief communication
Conditions influencing blood pressures in healthy gravidas C.V. SmithU , A.M. Miller, W.F. Rayburn Department of Obstetrics and Gynecology, The Uni¨ ersity of Nebraska College of Medicine, Omaha, NE, USA Received 4 August 1999; accepted 1 September 1999
Abstract The use of 24-h monitoring devices in healthy gravidas confirmed the suspicion that temporary blood pressure elevations relate to ambulation and to emotional upheaval, while the lowest recordings are associated with periods of rest. 䊚 2000 International Federation of Gynecology and Obstetrics. Keywords: Blood Pressure; Pregnancy; Prenatal counseling
The availability of ambulatory blood pressure ŽBP. monitoring permits the clinician to assess fluctuations in recordings during normal daily activities. The objective of the current investigation was to gather information about conditions influencing BP variations in a low-risk pregnancy population. Our investigational review board approved this study. Twenty-six women with uncomplicated pregnancies were recruited during the second half of gestation. The SpaceLabs 90207 monitor ŽSpaceLabs Inc., Redmond, WA, USA., that is U
Corresponding author. Tel.: q1-402-559-6150r334-4411; fax: q1-402-559-7126.
carried in a small pouch at the patient’s side, has been proven to be accurate w1x. The cuff was positioned around the patient’s dominant arm which measured 24᎐32 cm in circumference. A tone, emitted by the device before measurement, signaled the patient to remain motionless during the recording. Measurements were obtained every 20 min during the approximate 24 h of monitoring. Data were transmitted to a SpaceLabs ABP analysis system Ž90209 Data Interface Unit. for report generation. The patient was also asked to maintain a diary of physical activities Žstanding, sitting, reclining᎐awake, reclining᎐asleep. and emotional responses Žrelaxed, angry, anxious, etc.. during these recordings.
0020-7292r00r$20.00 䊚 2000 International Federation of Gynecology and Obstetrics. PII: S 0 0 2 0 - 7 2 9 2 Ž 9 9 . 0 0 1 7 1 - X
46
C.V. Smith et al. r International Journal of Gynecology & Obstetrics 68 (2000) 45᎐46
The mean maternal age was 25 " 5 years Žmean " S.D.., and non-Hispanic Caucasians constituted 84% of the study population. The mean gestational age was 32 " 3 weeks, and half were nulliparous. An average of 80 " 9 recordings was obtained per patient. Twenty-three Ž88.5%. patients met traditional criteria for isolated BP elevations Žsystolic G 30 mmHg above baseline, diastolic G 15 mmHg, or G 140r90. w2x. The most frequent form of BP elevation, a G 15 mmHg rise in baseline diastolic level, occurred on 8.3 Žrange 0᎐34. occasions per patient. Virtually all of the elevated readings were observed during ambulation or during periods of emotional upheaval. Conditions such as arguing, driving, or hurrying to an appointment were commonly reported during these episodes of BP elevations. Two or more BP elevations for 6 h apart were during the daytime only and consisted of elevations of the diastolic baseline Ž16 cases, 61.5%.. No patient developed sustained BP elevations for more than 1 day or manifested signs of pregnancy-induced hypertension in the clinic. The majority of patients had few or no BP recordings that were 30 mmHg above systolic baseline Žmean 0.93, range 0᎐11., G 140 mmHg
systolic Žmean 1.1, range 0᎐18., or G 90 mmHg diastole Žmean 1.0, range 0᎐3.. Reclining, while awake or asleep, was strongly associated with BP recordings being the same or lower than baseline. In summary, prolonged use of an accurate portable BP device confirmed the clinical suspicion that BP fluctuations occur frequently among healthy pregnant women. Elevations may be attributable to increased physical activity or to conditions provoking emotional distress. The lowest BP recordings were observed at rest, especially at night, when there was minimal stimulation. These findings may be helpful for prenatal counseling, especially for those at risk of developing pregnancy-induced hypertension or for those who have adopted stressful lifestyles. References w1x Meyer-Sabelllek W, Schulte KL, Gotzen R. Non-invasive ambulatory blood pressure monitoring: technical possibilities and problems. J Hypertens Suppl 1990;8:53᎐60. w2x O’Brien E, O’Malley K, Mee F, Atkins N, Cox J. Ambulatory blood pressure measurement in the diagnosis and management of hypertension. J Hum Hypertens 1991;5ŽSuppl 2.:23᎐30.
Brief communication
Conditions influencing blood pressures in healthy gravidas C.V. SmithU , A.M. Miller, W.F. Rayburn Department of Obstetrics and Gynecology, The Uni¨ ersity of Nebraska College of Medicine, Omaha, NE, USA Received 4 August 1999; accepted 1 September 1999
Abstract The use of 24-h monitoring devices in healthy gravidas confirmed the suspicion that temporary blood pressure elevations relate to ambulation and to emotional upheaval, while the lowest recordings are associated with periods of rest. 䊚 2000 International Federation of Gynecology and Obstetrics. Keywords: Blood Pressure; Pregnancy; Prenatal counseling
The availability of ambulatory blood pressure ŽBP. monitoring permits the clinician to assess fluctuations in recordings during normal daily activities. The objective of the current investigation was to gather information about conditions influencing BP variations in a low-risk pregnancy population. Our investigational review board approved this study. Twenty-six women with uncomplicated pregnancies were recruited during the second half of gestation. The SpaceLabs 90207 monitor ŽSpaceLabs Inc., Redmond, WA, USA., that is U
Corresponding author. Tel.: q1-402-559-6150r334-4411; fax: q1-402-559-7126.
carried in a small pouch at the patient’s side, has been proven to be accurate w1x. The cuff was positioned around the patient’s dominant arm which measured 24᎐32 cm in circumference. A tone, emitted by the device before measurement, signaled the patient to remain motionless during the recording. Measurements were obtained every 20 min during the approximate 24 h of monitoring. Data were transmitted to a SpaceLabs ABP analysis system Ž90209 Data Interface Unit. for report generation. The patient was also asked to maintain a diary of physical activities Žstanding, sitting, reclining᎐awake, reclining᎐asleep. and emotional responses Žrelaxed, angry, anxious, etc.. during these recordings.
0020-7292r00r$20.00 䊚 2000 International Federation of Gynecology and Obstetrics. PII: S 0 0 2 0 - 7 2 9 2 Ž 9 9 . 0 0 1 7 1 - X
46
C.V. Smith et al. r International Journal of Gynecology & Obstetrics 68 (2000) 45᎐46
The mean maternal age was 25 " 5 years Žmean " S.D.., and non-Hispanic Caucasians constituted 84% of the study population. The mean gestational age was 32 " 3 weeks, and half were nulliparous. An average of 80 " 9 recordings was obtained per patient. Twenty-three Ž88.5%. patients met traditional criteria for isolated BP elevations Žsystolic G 30 mmHg above baseline, diastolic G 15 mmHg, or G 140r90. w2x. The most frequent form of BP elevation, a G 15 mmHg rise in baseline diastolic level, occurred on 8.3 Žrange 0᎐34. occasions per patient. Virtually all of the elevated readings were observed during ambulation or during periods of emotional upheaval. Conditions such as arguing, driving, or hurrying to an appointment were commonly reported during these episodes of BP elevations. Two or more BP elevations for 6 h apart were during the daytime only and consisted of elevations of the diastolic baseline Ž16 cases, 61.5%.. No patient developed sustained BP elevations for more than 1 day or manifested signs of pregnancy-induced hypertension in the clinic. The majority of patients had few or no BP recordings that were 30 mmHg above systolic baseline Žmean 0.93, range 0᎐11., G 140 mmHg
systolic Žmean 1.1, range 0᎐18., or G 90 mmHg diastole Žmean 1.0, range 0᎐3.. Reclining, while awake or asleep, was strongly associated with BP recordings being the same or lower than baseline. In summary, prolonged use of an accurate portable BP device confirmed the clinical suspicion that BP fluctuations occur frequently among healthy pregnant women. Elevations may be attributable to increased physical activity or to conditions provoking emotional distress. The lowest BP recordings were observed at rest, especially at night, when there was minimal stimulation. These findings may be helpful for prenatal counseling, especially for those at risk of developing pregnancy-induced hypertension or for those who have adopted stressful lifestyles. References w1x Meyer-Sabelllek W, Schulte KL, Gotzen R. Non-invasive ambulatory blood pressure monitoring: technical possibilities and problems. J Hypertens Suppl 1990;8:53᎐60. w2x O’Brien E, O’Malley K, Mee F, Atkins N, Cox J. Ambulatory blood pressure measurement in the diagnosis and management of hypertension. J Hum Hypertens 1991;5ŽSuppl 2.:23᎐30.