Blood pressure trajectory and category and risk of hypertensive disorders of pregnancy in nulliparous women

Alisse Hauspurg, Samuel Parry, Brian M. Mercer, William Grobman, Tamera Hatfield, Robert M. Silver, Corette B. Parker, David Haas, J. D. Iams, George R. Saade, Ronald J. Wapner, U. M. Reddy, Hyagriv Simhan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Recently updated American College of Cardiology/ American Heart Association (ACC/AHA) guidelines redefine blood pressure categories as stage 1 hypertension (systolic, 130–139 mm Hg or diastolic, 80–89 mm Hg), elevated (systolic, 120–129 mm Hg and diastolic, <80 mm Hg), and normal (<120/<80 mm Hg), but their relevance to an obstetric population is uncertain. Objective: We sought to evaluate the risk of gestational hypertension or preeclampsia based on early pregnancy blood pressure category and trajectory. Study Design: We utilized data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort, a prospective observational study of nulliparous women with singleton pregnancies conducted at 8 clinical sites between 2010 and 2014. Women included in this analysis had no known history of prepregnancy hypertension (blood pressure, ≥140/90 mm Hg) or diabetes. We compared the frequency of hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension, among women based on ACC/AHA blood pressure category at a first-trimester study visit and blood pressure trajectory between study visits in the first and second trimesters. Blood pressure trajectories were categorized based on blood pressure difference between visits 1 and 2 as stable (<5 mm Hg difference), upward (≥5 mm Hg), or downward (≤-5 mm Hg). Associations of blood pressure category and trajectory with preeclampsia and gestational hypertension were assessed via univariate analysis and multinomial logistic regression analysis with covariates identified a priori. Results: A total of 8899 women were included in the analysis. Study visit 1 occurred at a mean gestational age of 11.6 ± 1.5 weeks and study visit 2 at a mean gestational age of 19.0 ± 1.6 weeks. First-trimester blood pressure category was significantly associated with both preeclampsia and gestational hypertension, with increasing blood pressure category associated with a higher risk of all hypertensive disorders of pregnancy. Elevated blood pressure was associated with an adjusted relative risk of 1.54 (95% confidence interval, 1.18–2.02) and stage 1 hypertension was associated with adjusted relative risk of 2.16 (95% confidence interval, 1.31–3.57) of any hypertensive disorder of pregnancy. Stage 1 hypertension was associated with the highest risk of preeclampsia with severe features, with an adjusted relative risk of 2.48 (95% confidence interval, 1.38–8.74). Both systolic and diastolic blood pressure trajectories were also significantly associated with the risk of hypertensive disorders of pregnancy independent of blood pressure category (P < .001). Women with a blood pressure categorized as normal and with an upward systolic trajectory had a 41% increased risk of any hypertensive disorder of pregnancy (adjusted relative risk, 1.41; 95% confidence interval, 1.20–1.65) compared to women with a downward systolic trajectory. Conclusion: In nulliparous women, blood pressure category and trajectory in early pregnancy are independently associated with risk of preeclampsia and gestational hypertension. Our study demonstrates that blood pressure categories with lower thresholds than those traditionally used to identify individuals as hypertensive may identify more women at risk for preeclampsia and gestational hypertension.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
DOIs
StatePublished - Jan 1 2019

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Blood Pressure
Pregnancy
Pregnancy Induced Hypertension
Pre-Eclampsia
First Pregnancy Trimester
Confidence Intervals
Hypertension
Gestational Age
American Heart Association
Second Pregnancy Trimester
Pregnancy Outcome
Cardiology
Obstetrics
Observational Studies
Logistic Models
Regression Analysis
Mothers
Outcome Assessment (Health Care)
Prospective Studies
Guidelines

Keywords

  • American College of Cardiology
  • American Heart Association
  • BP trajectory
  • chronic hypertension
  • gestational hypertension
  • guideline
  • hypertensive disorder
  • mild hypertension
  • preeclampsia
  • pregnancy
  • stage 1 hypertension

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Blood pressure trajectory and category and risk of hypertensive disorders of pregnancy in nulliparous women. / Hauspurg, Alisse; Parry, Samuel; Mercer, Brian M.; Grobman, William; Hatfield, Tamera; Silver, Robert M.; Parker, Corette B.; Haas, David; Iams, J. D.; Saade, George R.; Wapner, Ronald J.; Reddy, U. M.; Simhan, Hyagriv.

In: American Journal of Obstetrics and Gynecology, 01.01.2019.

Research output: Contribution to journalArticle

Hauspurg, A, Parry, S, Mercer, BM, Grobman, W, Hatfield, T, Silver, RM, Parker, CB, Haas, D, Iams, JD, Saade, GR, Wapner, RJ, Reddy, UM & Simhan, H 2019, 'Blood pressure trajectory and category and risk of hypertensive disorders of pregnancy in nulliparous women', American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2019.06.031
Hauspurg, Alisse ; Parry, Samuel ; Mercer, Brian M. ; Grobman, William ; Hatfield, Tamera ; Silver, Robert M. ; Parker, Corette B. ; Haas, David ; Iams, J. D. ; Saade, George R. ; Wapner, Ronald J. ; Reddy, U. M. ; Simhan, Hyagriv. / Blood pressure trajectory and category and risk of hypertensive disorders of pregnancy in nulliparous women. In: American Journal of Obstetrics and Gynecology. 2019.
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abstract = "Background: Recently updated American College of Cardiology/ American Heart Association (ACC/AHA) guidelines redefine blood pressure categories as stage 1 hypertension (systolic, 130–139 mm Hg or diastolic, 80–89 mm Hg), elevated (systolic, 120–129 mm Hg and diastolic, <80 mm Hg), and normal (<120/<80 mm Hg), but their relevance to an obstetric population is uncertain. Objective: We sought to evaluate the risk of gestational hypertension or preeclampsia based on early pregnancy blood pressure category and trajectory. Study Design: We utilized data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort, a prospective observational study of nulliparous women with singleton pregnancies conducted at 8 clinical sites between 2010 and 2014. Women included in this analysis had no known history of prepregnancy hypertension (blood pressure, ≥140/90 mm Hg) or diabetes. We compared the frequency of hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension, among women based on ACC/AHA blood pressure category at a first-trimester study visit and blood pressure trajectory between study visits in the first and second trimesters. Blood pressure trajectories were categorized based on blood pressure difference between visits 1 and 2 as stable (<5 mm Hg difference), upward (≥5 mm Hg), or downward (≤-5 mm Hg). Associations of blood pressure category and trajectory with preeclampsia and gestational hypertension were assessed via univariate analysis and multinomial logistic regression analysis with covariates identified a priori. Results: A total of 8899 women were included in the analysis. Study visit 1 occurred at a mean gestational age of 11.6 ± 1.5 weeks and study visit 2 at a mean gestational age of 19.0 ± 1.6 weeks. First-trimester blood pressure category was significantly associated with both preeclampsia and gestational hypertension, with increasing blood pressure category associated with a higher risk of all hypertensive disorders of pregnancy. Elevated blood pressure was associated with an adjusted relative risk of 1.54 (95{\%} confidence interval, 1.18–2.02) and stage 1 hypertension was associated with adjusted relative risk of 2.16 (95{\%} confidence interval, 1.31–3.57) of any hypertensive disorder of pregnancy. Stage 1 hypertension was associated with the highest risk of preeclampsia with severe features, with an adjusted relative risk of 2.48 (95{\%} confidence interval, 1.38–8.74). Both systolic and diastolic blood pressure trajectories were also significantly associated with the risk of hypertensive disorders of pregnancy independent of blood pressure category (P < .001). Women with a blood pressure categorized as normal and with an upward systolic trajectory had a 41{\%} increased risk of any hypertensive disorder of pregnancy (adjusted relative risk, 1.41; 95{\%} confidence interval, 1.20–1.65) compared to women with a downward systolic trajectory. Conclusion: In nulliparous women, blood pressure category and trajectory in early pregnancy are independently associated with risk of preeclampsia and gestational hypertension. Our study demonstrates that blood pressure categories with lower thresholds than those traditionally used to identify individuals as hypertensive may identify more women at risk for preeclampsia and gestational hypertension.",
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author = "Alisse Hauspurg and Samuel Parry and Mercer, {Brian M.} and William Grobman and Tamera Hatfield and Silver, {Robert M.} and Parker, {Corette B.} and David Haas and Iams, {J. D.} and Saade, {George R.} and Wapner, {Ronald J.} and Reddy, {U. M.} and Hyagriv Simhan",
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T1 - Blood pressure trajectory and category and risk of hypertensive disorders of pregnancy in nulliparous women

AU - Hauspurg, Alisse

AU - Parry, Samuel

AU - Mercer, Brian M.

AU - Grobman, William

AU - Hatfield, Tamera

AU - Silver, Robert M.

AU - Parker, Corette B.

AU - Haas, David

AU - Iams, J. D.

AU - Saade, George R.

AU - Wapner, Ronald J.

AU - Reddy, U. M.

AU - Simhan, Hyagriv

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Recently updated American College of Cardiology/ American Heart Association (ACC/AHA) guidelines redefine blood pressure categories as stage 1 hypertension (systolic, 130–139 mm Hg or diastolic, 80–89 mm Hg), elevated (systolic, 120–129 mm Hg and diastolic, <80 mm Hg), and normal (<120/<80 mm Hg), but their relevance to an obstetric population is uncertain. Objective: We sought to evaluate the risk of gestational hypertension or preeclampsia based on early pregnancy blood pressure category and trajectory. Study Design: We utilized data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort, a prospective observational study of nulliparous women with singleton pregnancies conducted at 8 clinical sites between 2010 and 2014. Women included in this analysis had no known history of prepregnancy hypertension (blood pressure, ≥140/90 mm Hg) or diabetes. We compared the frequency of hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension, among women based on ACC/AHA blood pressure category at a first-trimester study visit and blood pressure trajectory between study visits in the first and second trimesters. Blood pressure trajectories were categorized based on blood pressure difference between visits 1 and 2 as stable (<5 mm Hg difference), upward (≥5 mm Hg), or downward (≤-5 mm Hg). Associations of blood pressure category and trajectory with preeclampsia and gestational hypertension were assessed via univariate analysis and multinomial logistic regression analysis with covariates identified a priori. Results: A total of 8899 women were included in the analysis. Study visit 1 occurred at a mean gestational age of 11.6 ± 1.5 weeks and study visit 2 at a mean gestational age of 19.0 ± 1.6 weeks. First-trimester blood pressure category was significantly associated with both preeclampsia and gestational hypertension, with increasing blood pressure category associated with a higher risk of all hypertensive disorders of pregnancy. Elevated blood pressure was associated with an adjusted relative risk of 1.54 (95% confidence interval, 1.18–2.02) and stage 1 hypertension was associated with adjusted relative risk of 2.16 (95% confidence interval, 1.31–3.57) of any hypertensive disorder of pregnancy. Stage 1 hypertension was associated with the highest risk of preeclampsia with severe features, with an adjusted relative risk of 2.48 (95% confidence interval, 1.38–8.74). Both systolic and diastolic blood pressure trajectories were also significantly associated with the risk of hypertensive disorders of pregnancy independent of blood pressure category (P < .001). Women with a blood pressure categorized as normal and with an upward systolic trajectory had a 41% increased risk of any hypertensive disorder of pregnancy (adjusted relative risk, 1.41; 95% confidence interval, 1.20–1.65) compared to women with a downward systolic trajectory. Conclusion: In nulliparous women, blood pressure category and trajectory in early pregnancy are independently associated with risk of preeclampsia and gestational hypertension. Our study demonstrates that blood pressure categories with lower thresholds than those traditionally used to identify individuals as hypertensive may identify more women at risk for preeclampsia and gestational hypertension.

AB - Background: Recently updated American College of Cardiology/ American Heart Association (ACC/AHA) guidelines redefine blood pressure categories as stage 1 hypertension (systolic, 130–139 mm Hg or diastolic, 80–89 mm Hg), elevated (systolic, 120–129 mm Hg and diastolic, <80 mm Hg), and normal (<120/<80 mm Hg), but their relevance to an obstetric population is uncertain. Objective: We sought to evaluate the risk of gestational hypertension or preeclampsia based on early pregnancy blood pressure category and trajectory. Study Design: We utilized data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort, a prospective observational study of nulliparous women with singleton pregnancies conducted at 8 clinical sites between 2010 and 2014. Women included in this analysis had no known history of prepregnancy hypertension (blood pressure, ≥140/90 mm Hg) or diabetes. We compared the frequency of hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension, among women based on ACC/AHA blood pressure category at a first-trimester study visit and blood pressure trajectory between study visits in the first and second trimesters. Blood pressure trajectories were categorized based on blood pressure difference between visits 1 and 2 as stable (<5 mm Hg difference), upward (≥5 mm Hg), or downward (≤-5 mm Hg). Associations of blood pressure category and trajectory with preeclampsia and gestational hypertension were assessed via univariate analysis and multinomial logistic regression analysis with covariates identified a priori. Results: A total of 8899 women were included in the analysis. Study visit 1 occurred at a mean gestational age of 11.6 ± 1.5 weeks and study visit 2 at a mean gestational age of 19.0 ± 1.6 weeks. First-trimester blood pressure category was significantly associated with both preeclampsia and gestational hypertension, with increasing blood pressure category associated with a higher risk of all hypertensive disorders of pregnancy. Elevated blood pressure was associated with an adjusted relative risk of 1.54 (95% confidence interval, 1.18–2.02) and stage 1 hypertension was associated with adjusted relative risk of 2.16 (95% confidence interval, 1.31–3.57) of any hypertensive disorder of pregnancy. Stage 1 hypertension was associated with the highest risk of preeclampsia with severe features, with an adjusted relative risk of 2.48 (95% confidence interval, 1.38–8.74). Both systolic and diastolic blood pressure trajectories were also significantly associated with the risk of hypertensive disorders of pregnancy independent of blood pressure category (P < .001). Women with a blood pressure categorized as normal and with an upward systolic trajectory had a 41% increased risk of any hypertensive disorder of pregnancy (adjusted relative risk, 1.41; 95% confidence interval, 1.20–1.65) compared to women with a downward systolic trajectory. Conclusion: In nulliparous women, blood pressure category and trajectory in early pregnancy are independently associated with risk of preeclampsia and gestational hypertension. Our study demonstrates that blood pressure categories with lower thresholds than those traditionally used to identify individuals as hypertensive may identify more women at risk for preeclampsia and gestational hypertension.

KW - American College of Cardiology

KW - American Heart Association

KW - BP trajectory

KW - chronic hypertension

KW - gestational hypertension

KW - guideline

KW - hypertensive disorder

KW - mild hypertension

KW - preeclampsia

KW - pregnancy

KW - stage 1 hypertension

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