Daily Dose: Distinct Patterns of BP in Early Gestation Predict Hypertensive Disorders

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On July 25, 2023, we reported on a study published in the Journal of the American Heart Association that aimed to develop and validate predictive models using early pregnancy blood pressure (BP) trajectory patterns in the first 20 weeks of pregnancy for improved risk stratification for early‐ and later‐onset preeclampsia, and gestational hypertension (HTN).

The study

Researchers analyzed BP measurements and other data from the electronic medical records of approximately 250 000 healthy pregnant patients who gave birth at Kaiser Permanente Northern California hospitals between 2009 and 2019, all of whom were considered to be at low-to-moderate risk of developing hypertensive disorders of pregnancy based on US Preventive Services Task Force criteria. Patients with high-risk conditions, such as prior chronic hypertension, liver disease, or kidney disease, were excluded from the study.

The findings

From that data, the researchers developed and validated the 6 trajectories, which elicited “excellent” discrimination, with C-statistics ranging from 0.731 to 0.770. The observed discrimination, explained the researchers, was superior to that observed when using risk factors alone (0.688-0.695).

Three of the 6 BP trajectories observed in the first 20 weeks of pregnancy were able to identify nearly 3 in 4 patients (74%) who subsequently developed preeclampsia in the latter half of their pregnancy as well as 82% of gestational hypertension outcomes in more than half (52%) of the study group.

Authors' commentary

"In the future, these findings may be translated into an automated clinical tool within the electronic health records system, or a web‐based tool to classify BP pattern changes during early gestation for individual risk stratification of preeclampsia or gestational hypertension that may improve precision medicine by more accurately identifying patients who may truly benefit most from enhanced monitoring and intervention(s)."

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