Blood Pressure and Prediction of Preeclampsia

Among the several risk factors of preeclampsia (PE), blood pressure (BP) elevation could be one of the earliest and most reliable signs of the disease. Various BP parameters, such as mean arterial pressure, ambulatory BP, and home BP, could be useful for the prediction of PE in pregnant women. When a pregnant woman before 20th gestational week has high BP, three possibilities can be considered: white-coat hypertension, sustained hypertension, and hypertension with chronic kidney disease. White-coat hypertension can be diagnosed by home BP monitoring or ambulatory BP monitoring (ABPM), and not at high risk for PE. So antihypertensive drugs are usually not necessary. In the case of sustained hypertension, early treatment is usually needed, but in some patients with sustained hypertension, BP can be normalized early in the course of pregnancy because of the physiological fall of BP. On the other hand, caution is needed for mild hypertension with CKD. Although most of the components of maternal outcomes depend on baseline levels of renal function, high BP can exacerbate renal functions of these patients, even during pregnancy. In this situation, the BP target is set as <140/90mmH. In case of essential hypertension during pregnancy, the risk of ‘preexisting hypertension plus superimposed gestational hypertension with proteinuria’ would be a previous history of preeclampsia and mild BP elevation such as SBP 130 139 mm Hg, and DBP 80 89 mm Hg. Appropriate BP control using antihypertensive medication other than renin angiotensin aldosterone system blockers is needed. Special Issue on Prediction of Preeclampsia