Hypertension in Type 2 Diabetic Pregnancy: 24 hour Ambulatory Blood Pressure Monitoring vs. Conventional Office Measurement

Belinfante, E. (Esya) (2014) Hypertension in Type 2 Diabetic Pregnancy: 24 hour Ambulatory Blood Pressure Monitoring vs. Conventional Office Measurement. thesis, Medicine.

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Abstract

Background: There are only few data on hypertension in type 2 diabetic pregnancy. Its impact on type 2 diabetic pregnancies has been hard to predict, also due to the limits of conventional blood pressure measurement using a sphygmomanometer. However, nowadays new technologies exist that give relevant additional information on blood pressure. Objective: Our primary aims were: 1) To determine the additional value of 24h-BP monitoring (ABPM) in term of hypertension prevalence and prediction of pregnancy outcome in comparison to conventional approach. 2) To characterize and model the blood pressure profiles of the type 2 diabetic women that developed hypertension during pregnancy. Retrospective study design: 52 type 2 diabetic pregnant women, age 24-39yrs, diabetes duration of at least 1 year (on average 9.5yrs), and average pregestational BMI of 26.99kg/m2 were followed throughout entire pregnancy. Blood pressure was measured with both the conventional method and 24h-ABPM. According to the guidelines, hypertension (Cuff BP levels140/90mmHg) was classified as chronic, gestational, or preeclampsia. The 24h-ABPM (cut-offs 24hr130/80, daytime135/85, night-time120/70mmHg) defined white-coat, sustained and masked hypertension. Statistical Analysis: Data were processed using the IBM program ‘SPSS 20’. Chi-square, Fisher’s and Kruskal-Wallis tests were performed when appropriate. P-values <0.05 were considered significant. Results: The two methods classified different patients as hypertensive. Using 24h-ABPM, 18 out of 52 diagnoses of hypertension had to be changed. 11 patients with masked hypertension and 7 patients with white-coat hypertension were uncovered, thus revealing 17 treatment-needing hypertensive cases (32.69%) and hypothetically sparing 7 from unnecessarily intensive therapy. Short-term variability of both daytime (p<0.034) and 24h-measurements (p<0.001) in the third trimester of hypertensive women were significantly higher than in normotensive women. 24h-ABPM curves of women who later developed hypertension were consistently higher since the first trimester than of those who didn’t. Hypertensive disorders did not alter maternal-fetal outcome, likely because of the treatment and moderate of hypertension (just one case with PE). Conclusions: 24h-ABPM showed significantly more accuracy in diagnosing and predicting the onset of hypertension already since the first trimester. Moreover, it succeeded in identifying masked, sustained and white-coat hypertension over the conventional method, fundamentally improving the opportunity for appropriate treatment.

Item Type:	Thesis (Thesis)
Supervisor name:	Napoli, Angela and Lutgers, Helen and Roma, Giona and Department of Clinical Sciences, Endocrinology. Sant’Andrea and University of Rome, Italy.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:01
Last Modified:	25 Jun 2020 11:01
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2114

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