Predicting transformation from gestational hypertension to preeclampsia in clinical practice: a possible role for 24 hour ambulatory blood pressure monitoring.
OBJECTIVE
To identify parameters that may assist clinicians in predicting which women will develop preeclampsia (PE) after initially presenting with gestational hypertension (GH).


METHODS
118 women were recruited to the study with GH or PE. They were divided into three groups based on their diagnosis at delivery- (1) GH, (2) PE from the time of presentation, (3) those with an initial diagnosis of GH who progressed to PE. Women underwent 24 hour ambulatory blood pressure monitoring (ABPM) and had serum estrogen, progesterone, beta-HCG, leptin and adiponectin measured as possible predictors of transformation of GH to PE.


RESULTS
Women who presented with GH, and progressed to PE, presented four weeks earlier (33 vs 37 weeks, p < 0.001) than those who did not progress. Women with PE, either as their initial diagnosis or after progression from GH, were delivered earlier (p < 0.001) and had more small for gestational age (SGA) babies than women with GH at delivery (p < 0.05). Those who developed PE after presenting with GH generally had higher blood pressures than those who remained as GH, significant for awake and 24 hour systolic blood pressures (p < 0.05). beta-HCG, estrogen, progesterone or leptin values were similar across the groups. Adiponectin was higher in women with established PE at presentation compared to women with GH (p = 0.02) but adiponectin failed to discriminate those women with an initial diagnosis of GH who progressed to PE.


CONCLUSIONS
24 hr ABPM may provide a non-invasive method of identifying this 'at risk' GH population, particularly in the case of early presentation.
Davis
Gregory K
GK
Department of Women's Health, St George Hospital and University of New South Wales, Kogarah, Sydney, NSW, Australia. davisg@sesiahs.health.nsw.gov.au
Mackenzie
Callie
C
Brown
Mark A
MA
Homer
Caroline S
CS
Holt
Jane
J
McHugh
Lisa
L
Mangos
George
G
D052242:Adiponectin / Q000097:blood; D000328:Adult; D018660:Blood Pressure Monitoring, Ambulatory; D018450:Disease Progression; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000473:pathology* / Q000503:physiopathology; D020738:Leptin / Q000097:blood; D010920:Placenta / Q000503:physiopathology; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D011247:Pregnancy; D012680:Sensitivity and Specificity
D052242:Adiponectin; D020738:Leptin