HOME BLOOD-PRESSURE MEASUREMENTS AND 24 H OURS-ABPM IN MILD PREGNANCY-ASSOCIATED HYPERTENSION

Pregnancy-associated hypertension (PAH) continues to be a concern to c linicians and often prompts pharmacological interventions that may cau se side effects, including decreased uteroplacental blood flow and ret arded fetal growth. The diagnosis of PAH is not necessarily easy. We c ompared blood pressure values from automated, ambulatory blood pressur e measurements (ABP), self-recorded, home blood pressure measurements (HBP), and blood pressure values obtained in the physician's office (O BP). Twenty-six women were diagnosed as having PAH because of OBP 145/ 91 mmHg. The HBP values of these women were 130/84 mmHg (p < 0.01). In a subgroup of fourteen women with OBP 148/91 mmHg we had HBP values o f 132/84 mmHg and ABP values of 131/79 mmHg (p < 0.01). The HBP and AB P values of these women were not different (P = NS). These results ind icate that ''white coat'', or office hypertension is common in pregnan t women. Inappropriate treatment could be avoided in these women by co nsidering HBP or ABP values. Since ABP provided no additional clinical benefit over HBP, we recommend that simply teaching pregnant women to monitor their own blood pressure and providing them with an instrumen t to do so, is sufficient to reduce risk of unwarranted treatment at a lower cost. All women with presumed PAH, who do not have overt signs of end-organ damage, such as proteinuria, cardiomegaly etc., should un dergo HBP to exclude a possible ''white coat'' or office effect on blo od pressure before any treatment is begun.