Blood Pressure Monitoring in Women with Previous Diagnosis of Preeclampsia: The Influence of the Menstrual Cycle

Objective: To evaluate 24-h ambulatory blood pressure (24h amb BP) and its relation to the menstrual cycle in women with previous preeclampsia (PE). Study Design: A case-control study, 2×2 factorial (group x phase), was undertaken at Karolinska Hospital, Stockholm, Sweden. The subjects, 25 women with a history of moderate to severe PE, were included 2-5 years after pregnancy. Twenty-four women with normal pregnancies matched for age, parity at index pregnancy, and time of delivery served as controls. Half of the subjects started recordings in the follicular phase and the other half in the luteal phase of the menstrual cycle. Main Outcome Measures: Diurnal blood pressure (BP) recording in the early follicular and the late luteal phases of the menstrual cycle. Blood samples were drawn for determination of estradiol, progesterone, aldosterone, plasma renin activity, plasma angiotensin II, and angiotensin-converting enzyme. Results: The BP values were significantly higher in women with previous PE, including 24h amb BP, mean day BP, mean night BP (p < 0.01). There were no phase differences in mean 24h amb BP. Mean diastolic BP (DBP) and mean arterial pressure (MAP) recordings at night in the luteal phase were lower than in the follicular phase in both groups (p < 0.05). In a group of PE patients with one or more BP readings ≥ 140/90 mm Hg at night (n = 11), the mean 24h amb BP, MAP, angiotensin II, and renin activity were significantly higher compared to the group with no BP readings ≥ 140/90 mm Hg at night. Conclusion: Two to five years after pregnancy, women with a diagnosis of PE have a significantly higher 24h amb BP compared to women with normal pregnancies. A blunted diurnal BP reaction at night in the follicular phase compared to the luteal phase was seen mainly in the group of women with previous PE.