Reversed circadian blood pressure rhythm preserves fetal growth in preeclamptic pregnancy.
OBJECTIVE
To determine the clinical trait of hypertension in pregnant women with a reversed circadian blood pressure (BP) rhythm.


METHODS
24-h BP monitoring was performed in 56 hypertensive pregnant women, of whom 12 had a reversed systolic BP (SBP) rhythm (day/night mean BP ratio < 1.0). Clinical data, ultrasound fetometry and umbilical artery velocimetry were compared to that in women with a normal rhythm. Statistical analyses were performed with simple linear regression, Mann-Whitney U test, analysis of variance, contingency table analysis and Fisher's test. A two-tailed P value of < 0.05 was considered significant.


RESULTS
In the reversed SBP group, the nighttime BP, fetal weight, albuminuria and S-urate were higher, and the BP variations smaller. The birthweight correlated negatively to the SBP day/night ratio. Higher SBP day/night ratios and larger BP variations were associated with an increased vascular resistance in the umbilical artery and an impaired growth.


CONCLUSIONS
A reversed SBP rhythm was associated with a more severe degree of preeclampsia, but also with a smaller BP variation, maintenance of fetal growth, and higher birthweight. A sustained high nighttime BP preserved fetal growth. These novel observations challenge the opinion that a reversed circadian BP rhythm is merely an ominous sign.
Olofsson
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P
Dept. of Obstetrics and Gynecology, University of Lund, Malmö University Hospital, Sweden.
Poulsen
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H
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000419:Albuminuria; D001219:Aspartate Aminotransferases / Q000097:blood; D001794:Blood Pressure; D015992:Body Mass Index; D002940:Circadian Rhythm; D005314:Embryonic and Fetal Development; D005260:Female; D005865:Gestational Age; D006801:Humans; D010976:Platelet Count; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy; D014527:Uric Acid / Q000097:blood
D014527:Uric Acid; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase