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Hypertension. 2018 Sep;72(3):686-694. doi: 10.1161/HYPERTENSIONAHA.118.10917.

How Do Home and Clinic Blood Pressure Readings Compare in Pregnancy?

Author information

1
From the Nuffield Department of Primary Care Health Sciences (K.L.T., C.B., R.S., C.H., C.C., K.S.T., R.J.M.).
2
Institute of Applied Health Research, University of Birmingham, United Kingdom (J.H.).
3
Bodleian Health Care Libraries (N.R.), University of Oxford, United Kingdom.
4
Obstetric, Medicine Division, Department of Obstetrics and Gynecology, CHU Ste-Justine, Montreal, Quebec, Canada (É.R.).
5
Omnicare Women's Health Centre, Auckland, New Zealand (C.L.).
6
Guy's and St Thomas' NHS Foundation Trust, Department of Women's Health, St Thomas' Hospital, London, United Kingdom (M.C.).
7
Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand (R.S.T., J.W.).
8
Auckland City Hospital, New Zealand (R.A.N.).
9
Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (A.K.).
10
Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom (A.K.).
11
Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom (A.K.).
12
Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, DC (K.M.).
13
Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom (J.W.).
14
Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand (J.W.).
15
Department of Renal Medicine; St. George Hospital and University of NSW, Sydney, Australia (M.B.).
16
Oxford University Hospitals NHS Foundation Trust, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom (L.M.).

Abstract

Hypertensive disorders during pregnancy result in substantial maternal morbidity and are a leading cause of maternal deaths worldwide. Self-monitoring of blood pressure (BP) might improve the detection and management of hypertensive disorders of pregnancy, but few data are available, including regarding appropriate thresholds. This systematic review and individual patient data analysis aimed to assess the current evidence on differences between clinic and self-monitored BP through pregnancy. MEDLINE and 10 other electronic databases were searched for articles published up to and including July 2016 using a strategy designed to capture all the literature on self-monitoring of BP during pregnancy. Investigators of included studies were contacted requesting individual patient data: self-monitored and clinic BP and demographic data. Twenty-one studies that utilized self-monitoring of BP during pregnancy were identified. Individual patient data from self-monitored and clinic readings were available from 7 plus 1 unpublished articles (8 studies; n=758) and 2 further studies published summary data. Analysis revealed a mean self-monitoring clinic difference of ≤1.2 mm Hg systolic BP throughout pregnancy although there was significant heterogeneity (difference in means, I2 >80% throughout pregnancy). Although the overall population difference was small, levels of white coat hypertension were high, particularly toward the end of pregnancy. The available literature includes no evidence of a systematic difference between self and clinic readings, suggesting that appropriate treatment and diagnostic thresholds for self-monitoring during pregnancy would be equivalent to standard clinic thresholds.

KEYWORDS:

blood pressure; hypertension; pre-eclampsia; pregnancy; white coat hypertension

PMID:
30354754
PMCID:
PMC6080884
DOI:
10.1161/HYPERTENSIONAHA.118.10917
[Indexed for MEDLINE]
Free PMC Article

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