The natural history of white coat hypertension during pregnancy

Brown, MA; Mangos, G; Davis, G; Homer, C

The natural history of white coat hypertension during pregnancy

Brown, MA Mangos, G Davis, G Homer, C

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Publication Type:: Journal Article
Citation:: BJOG: An International Journal of Obstetrics and Gynaecology, 2005, 112 (5), pp. 601 - 606
Issue Date:: 2005-05-01

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Field	Value	Language
dc.contributor.author	Brown, MA	en_US
dc.contributor.author	Mangos, G	en_US
dc.contributor.author	Davis, G	en_US
dc.contributor.author	Homer, C https://orcid.org/0000-0002-7454-3011	en_US
dc.date.issued	2005-05-01	en_US
dc.identifier.citation	BJOG: An International Journal of Obstetrics and Gynaecology, 2005, 112 (5), pp. 601 - 606	en_US
dc.identifier.issn	1470-0328	en_US
dc.identifier.uri	http://hdl.handle.net/10453/4725
dc.description.abstract	Objective: White coat hypertension (WCH) is a common phenomenon with a long term prognosis intermediate between those with true hypertension and true normotension. The natural history of this phenomenon throughout pregnancy remains unknown. We assessed the likelihood of women with an initial diagnosis of WCH developing pre-eclampsia (PE) as their pregnancy progressed. Design: Prospective observational study. Setting: St George Hospital, a teaching and University hospital. Population: Two hundred and forty-one pregnant women with an early pregnancy diagnosis of essential hypertension (EH). Methods: Eighty-six women had this diagnosis (EH) confirmed pre-pregnancy by 24-hour ambulatory blood pressure monitoring (ABPM) or repeated automated home blood pressure (BP) self-measurement. The remaining 155 underwent 24-hour ABPM in early pregnancy to establish their diagnosis. Women found to have WCH did not receive antihypertensives during their pregnancy, whereas those with confirmed EH received oxprenolol or methyldopa. Women with WCH had repeated 24-hour ABPM and/or BP assessments in a pregnancy day assessment unit until delivery. Main outcome measure: The development of PE in women with WCH or EH. Results: The overall prevalence of WCH was 32%. Half retained this phenomenon throughout pregnancy and had good pregnancy outcomes. Forty percent developed (benign) gestational hypertension and also had good pregnancy outcomes while 8% developed proteinuric PE, significantly fewer than in women with confirmed EH (22%), P = 0.008. No BP parameter at study entry permitted discrimination between those women with WCH who retained this phenomenon and those who developed GH or PE. Conclusion: WCH is a common phenomenon in pregnant women who appear to have EH according to routine BP measurement early in pregnancy. Antihypertensives may be withheld from this group initially and they can be advised they will have better pregnancy outcomes than women with true EH. However, continued monitoring throughout pregnancy remains important to detect the small group of white coat hypertensives who develop PE. © RCOG 2004 BJOG: an International Journal of Obstetrics and Gynaecology.	en_US
dc.relation.ispartof	BJOG: An International Journal of Obstetrics and Gynaecology	en_US
dc.relation.isbasedon	10.1111/j.1471-0528.2004.00516.x	en_US
dc.subject.classification	Obstetrics & Reproductive Medicine	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Pregnancy Complications, Cardiovascular	en_US
dc.subject.mesh	Hypertension	en_US
dc.subject.mesh	Blood Pressure Monitoring, Ambulatory	en_US
dc.subject.mesh	Pregnancy Outcome	en_US
dc.subject.mesh	Prevalence	en_US
dc.subject.mesh	Prospective Studies	en_US
dc.subject.mesh	Pregnancy	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Female	en_US
dc.title	The natural history of white coat hypertension during pregnancy	en_US
dc.type	Journal Article
utslib.citation.volume	5	en_US
utslib.citation.volume	112	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	11 Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
pubs.organisational-group	/University of Technology Sydney/Strength - WHO CC
utslib.copyright.status	closed_access
pubs.issue	5	en_US
pubs.publication-status	Published	en_US
pubs.volume	112	en_US

Abstract:

Objective: White coat hypertension (WCH) is a common phenomenon with a long term prognosis intermediate between those with true hypertension and true normotension. The natural history of this phenomenon throughout pregnancy remains unknown. We assessed the likelihood of women with an initial diagnosis of WCH developing pre-eclampsia (PE) as their pregnancy progressed. Design: Prospective observational study. Setting: St George Hospital, a teaching and University hospital. Population: Two hundred and forty-one pregnant women with an early pregnancy diagnosis of essential hypertension (EH). Methods: Eighty-six women had this diagnosis (EH) confirmed pre-pregnancy by 24-hour ambulatory blood pressure monitoring (ABPM) or repeated automated home blood pressure (BP) self-measurement. The remaining 155 underwent 24-hour ABPM in early pregnancy to establish their diagnosis. Women found to have WCH did not receive antihypertensives during their pregnancy, whereas those with confirmed EH received oxprenolol or methyldopa. Women with WCH had repeated 24-hour ABPM and/or BP assessments in a pregnancy day assessment unit until delivery. Main outcome measure: The development of PE in women with WCH or EH. Results: The overall prevalence of WCH was 32%. Half retained this phenomenon throughout pregnancy and had good pregnancy outcomes. Forty percent developed (benign) gestational hypertension and also had good pregnancy outcomes while 8% developed proteinuric PE, significantly fewer than in women with confirmed EH (22%), P = 0.008. No BP parameter at study entry permitted discrimination between those women with WCH who retained this phenomenon and those who developed GH or PE. Conclusion: WCH is a common phenomenon in pregnant women who appear to have EH according to routine BP measurement early in pregnancy. Antihypertensives may be withheld from this group initially and they can be advised they will have better pregnancy outcomes than women with true EH. However, continued monitoring throughout pregnancy remains important to detect the small group of white coat hypertensives who develop PE. © RCOG 2004 BJOG: an International Journal of Obstetrics and Gynaecology.

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http://hdl.handle.net/10453/4725