Differences between office, home, and 24-hour ambulatory blood pressure monitoring in pregnant women with preeclampsia and uncomplicated hypertension.

Introduction: Definition and management of arterial hypertension are based on office blood pressure measurement (OBPM), both in the general and pregnant population. However, in clinical practice, home BPM (HBPM) or 24‑hour ambulatory BP monitoring (ABPM) seem to be more accurate. Data on differences between BP assessment methods in pregnancy are scarce.

Objectives: We aimed to assess the BP profiles during pregnancy and compare the results of HBPM, OBPM, and ABPM performed simultaneously, in real clinical setting, with respect to hypertensive status and development of preeclampsia (PE).

Patients and methods: In the years 2017-2023, a total of 241 women were examined prospectively each month throughout pregnancy, and at 6-8 weeks, 6 months, and 1 year postdelivery. On each visit, HBPM, OBPM, and ABPM data were collected.

Results: Forty normotensive controls and 201 hypertensive (HT) women were recruited. PE developed in 49 cases (HT+PE). BP of the controls differed markedly from complicated (HT+PE) and uncomplicated HT for all 3 methods (P <0.05), and there were significant differences between the HT+PE and HT groups from 23 weeks of gestation until delivery: in the PE group systolic BP / diastolic BP was higher for OBPM (by 4/4.5-10/6 mm Hg), HBPM (by 4.2/3.6-7.1/8.4 mm Hg), and night‑time ABPM (by 9/5-16.5/9 mm Hg). At the same time, daytime ABPM differences were mostly insignificant.

Conclusions: Considerably higher BP values indicated PE on HBPM, OBPM, and night‑time ABPM readings, as compared with uncomplicated HT, even 2 months before average time of PE recognition. Night‑time ABPM seems to have the strongest predictive and diagnostic value for early PE recognition.