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TOPLINE:

An increasing diastolic blood pressure (BP) pattern was associated with an elevated risk for adverse maternal outcomes in late gestational hypertension (GH) and non-severe preeclampsia (PE).

METHODOLOGY:

• Researchers studied BP patterns in GH or non-severe PE to assess maternal outcomes for risk management.
• Of the 703 participants in the expectant management group of the HYPITAT study, 384 women were selected for the 1-week BP pattern analysis.
• GH was defined as diastolic BP ≥ 95 mm Hg on two occasions at least 6 hours apart; PE was defined as diastolic BP ≥ 90 mm Hg with proteinuria.
• BP measurements were taken over a 1-week period post-admission, and k-means clustering was used to identify BP change patterns.
• Researchers conducted a secondary analysis of a randomised controlled trial to identify diastolic BP change patterns and assess their link to adverse maternal outcomes (severe maternal morbidity, mortality, postpartum haemorrhage, and the need for caesarean section) using crude and adjusted models.

TAKEAWAY:

• Four diastolic BP patterns were identified: Steady in 54.2% of women, increasing in 16.9%, U-shaped in 15.4%, and decreasing in 13.5%.
• Diastolic BP patterns varied by ethnicity (P = .01) and diagnosis at admission (P = .043).
• Overall, 48.7% of women experienced adverse maternal outcomes, with 41.2% of these women taking oral medication at admission vs only 34.0% of women without adverse outcomes taking oral medication.
• After excluding cases of severe hypertension from the adverse maternal outcomes, the association between increasing diastolic BP and adverse maternal outcomes was analysed and no significant association was found (aOR, 1.51; P = .24).

IN PRACTICE:

"A pattern of increasing diastolic BP was likely associated with elevated risk of the adverse maternal outcome compared to non-elevated risk in women if BP did not increase. Although the association may seem self-evident, the change pattern clusters uniquely quantify and support this common clinical knowledge," the authors wrote.

SOURCE:

This study was led by Guiyou Yang, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. It was published online on February 28, 2025, in Pregnancy Hypertension.

LIMITATIONS:

The study's primary limitation was its small sample size, limiting generalisability despite a high incidence of adverse events. Additionally, there was a possibility of intervention bias as decisions to induce delivery could have influenced outcomes. The study also lacked details on BP measurement devices, with manual measurements assumed as per Dutch guidelines.

DISCLOSURES:

The HYPITAT study was funded by ZonMw. No specific funding was provided for this post hoc analysis. The authors reported that they had no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.