Beat-to-Beat Heart Rate and Blood Pressure Variability and Hypertensive Disease in Pregnancy

Abstract

Objective The aim of this study is to determine the relationship between heart rate and/or blood pressure variability, measured at 28 weeks' gestation, and the incidence of pregnancy-induced hypertension or preeclampsia.

Study Design Secondary analysis of data from a prospectively enrolled cohort of 385 active military women in whom spectral analysis of continuous heart rate and variability was measured at 28 weeks' gestation. The primary outcome was the predictive value of spectral analysis of heart rate and blood pressure for hypertensive diseases of pregnancy.

Results High-frequency heart rate variability was reduced and low-frequency variability of systolic and diastolic blood pressure increased in women who would develop pregnancy-induced hypertension but not preeclampsia. Low-frequency variability of diastolic blood pressure remained a significant predictor of pregnancy-induced hypertension but not preeclampsia after adjustment for age, weight, and blood pressure in a multivariate model.

Conclusion Early identification of pregnancy-induced hypertension can facilitate treatment to avoid maternal morbidity. Understanding the physiological underpinnings of the two very different diseases may lead to improved treatment and prevention. If proven effective in a broader population, the ability to differentiate pregnancy-induced hypertension from preeclampsia may reduce unnecessary iatrogenic interventions or inappropriate preterm delivery.

Keywords

hypertensive diseases of pregnancy - autonomic function - heart rate variability - blood pressure variability

Note

The cohort was assembled at Lackland Air force Base, San Antonio, TX when Dr. Hatch was a faculty member at Mt. Sinai Hospital, New York, NY. Reprints will not be available

• References

• 1 Macdonald-Wallis C, Lawlor DA, Fraser A, May M, Nelson SM, Tilling K. Blood pressure change in normotensive, gestational hypertensive, preeclamptic, and essential hypertensive pregnancies. Hypertension 2012; 59 (6) 1241-1248
• 2 Berntson GG, Bigger Jr JT, Eckberg DL , et al. Heart rate variability: origins, methods, and interpretive caveats. Psychophysiology 1997; 34 (6) 623-648
• 3 Berntson GG, Hart S, Ruland S, Sarter M. A central cholinergic link in the cardiovascular effects of the benzodiazepine receptor partial inverse agonist FG 7142. Behav Brain Res 1996; 74 (1-2) 91-103
• 4 Yang CC, Chao TC, Kuo TB, Yin CS, Chen HI. Preeclamptic pregnancy is associated with increased sympathetic and decreased parasympathetic control of HR. Am J Physiol Heart Circ Physiol 2000; 278 (4) H1269-H1273
• 5 Stauss HM. Identification of blood pressure control mechanisms by power spectral analysis. Clin Exp Pharmacol Physiol 2007; 34 (4) 362-368
• 6 deBoer RW, Karemaker JM, Strackee J. Hemodynamic fluctuations and baroreflex sensitivity in humans: a beat-to-beat model. Am J Physiol 1987; 253 (3 Pt 2) H680-H689
• 7 Montano N, Lombardi F, Gnecchi Ruscone T , et al. Spectral analysis of sympathetic discharge, R-R interval and systolic arterial pressure in decerebrate cats. J Auton Nerv Syst 1992; 40 (1) 21-31
• 8 Dimier-David L, Billon N, Costagliola D, Jaillon P, Funck-Brentano C. Reproducibility of non-invasive measurement and of short-term variability of blood pressure and heart rate in healthy volunteers. Br J Clin Pharmacol 1994; 38 (2) 109-115
• 9 Cevese A, Grasso R, Poltronieri R, Schena F. Vascular resistance and arterial pressure low-frequency oscillations in the anesthetized dog. Am J Physiol 1995; 268 (1 Pt 2) H7-H16
• 10 Mukai S, Hayano J. Heart rate and blood pressure variabilities during graded head-up tilt. J Appl Physiol (1985) 1995; 78 (1) 212-216
• 11 Cooke WH, Hoag JB, Crossman AA, Kuusela TA, Tahvanainen KU, Eckberg DL. Human responses to upright tilt: a window on central autonomic integration. J Physiol 1999; 517 (Pt 2): 617-628
• 12 Schächinger H, Weinbacher M, Kiss A, Ritz R, Langewitz W. Cardiovascular indices of peripheral and central sympathetic activation. Psychosom Med 2001; 63 (5) 788-796
• 13 Ditor DS, Kamath MV, Macdonald MJ, Bugaresti J, McCartney N, Hicks AL. Reproducibility of heart rate variability and blood pressure variability in individuals with spinal cord injury. Clin Auton Res 2005; 15 (6) 387-393
• 14 Hatch M, Berkowitz G, Janevic T , et al. Race, cardiovascular reactivity, and preterm delivery among active-duty military women. Epidemiology 2006; 17 (2) 178-182
• 15 Harris FJ. On the use of windows for harmonic analysis with discrete Fourier transorm. Proc IEEE 1978; 66 (1) 51-83
• 16 Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol 2003; 3: 21
• 17 Begum KS, Sachchithanantham K, De Somsubhra S. Maternal obesity and pregnancy outcome. Clin Exp Obstet Gynecol 2011; 38 (1) 14-20
• 18 Salihu HM, De La Cruz C, Rahman S, August EM. Does maternal obesity cause preeclampsia? A systematic review of the evidence. Minerva Ginecol 2012; 64 (4) 259-280
• 19 Parati G, Grassi G, Coruzzi P , et al. Influence of cardiopulmonary receptors on the bradycardic responses to carotid baroreceptor stimulation in man. Clin Sci (Lond) 1987; 72 (5) 639-645
• 20 Frattola A, Parati G, Cuspidi C, Albini F, Mancia G. Prognostic value of 24-hour blood pressure variability. J Hypertens 1993; 11 (10) 1133-1137
• 21 Sander D, Kukla C, Klingelhöfer J, Winbeck K, Conrad B. Relationship between circadian blood pressure patterns and progression of early carotid atherosclerosis: A 3-year follow-up study. Circulation 2000; 102 (13) 1536-1541
• 22 Mancia G, Parati G, Hennig M , et al; ELSA Investigators. Relation between blood pressure variability and carotid artery damage in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis (ELSA). J Hypertens 2001; 19 (11) 1981-1989
• 23 Mancia G, Bousquet P, Elghozi JL , et al. The sympathetic nervous system and the metabolic syndrome. J Hypertens 2007; 25 (5) 909-920
• 24 Mancia G. Blood pressure reduction and cardiovascular outcomes: past, present, and future. Am J Cardiol 2007; 100 (3A): 3J-9J
• 25 Xie HH, Zhang XF, Chen YY, Shen FM, Su DF. Synergism of hydrochlorothiazide and nifedipine on blood pressure variability reduction and organ protection in spontaneously hypertensive rats. Hypertens Res 2008; 31 (4) 685-691
• 26 Rothwell PM. Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. Lancet 2010; 375 (9718) 938-948
• 27 Muntner P, Shimbo D, Tonelli M, Reynolds K, Arnett DK, Oparil S. The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in the general population: findings from NHANES III, 1988 to 1994. Hypertension 2011; 57 (2) 160-166
• 28 Mena L, Pintos S, Queipo NV, Aizpúrua JA, Maestre G, Sulbarán T. A reliable index for the prognostic significance of blood pressure variability. J Hypertens 2005; 23 (3) 505-511
• 29 Schillaci G, Pucci G, Parati G. Blood pressure variability: an additional target for antihypertensive treatment?. Hypertension 2011; 58 (2) 133-135
• 30 Zhang Y, Agnoletti D, Safar ME, Blacher J. Effect of antihypertensive agents on blood pressure variability: the Natrilix SR versus candesartan and amlodipine in the reduction of systolic blood pressure in hypertensive patients (X-CELLENT) study. Hypertension 2011; 58 (2) 155-160
• 31 Carr DB, McDonald GB, Brateng D, Desai M, Thach CT, Easterling TR. The relationship between hemodynamics and inflammatory activation in women at risk for preeclampsia. Obstet Gynecol 2001; 98 (6) 1109-1116
• 32 Silver HM, Tahvanainen KU, Kuusela TA, Eckberg DL. Comparison of vagal baroreflex function in nonpregnant women and in women with normal pregnancy, preeclampsia, or gestational hypertension. Am J Obstet Gynecol 2001; 184 (6) 1189-1195
• 33 Ekholm EM, Tahvanainen KU, Metsälä T. Heart rate and blood pressure variabilities are increased in pregnancy-induced hypertension. Am J Obstet Gynecol 1997; 177 (5) 1208-1212
• 34 Greenwood JP, Stoker JB, Walker JJ, Mary DA. Sympathetic nerve discharge in normal pregnancy and pregnancy-induced hypertension. J Hypertens 1998; 16 (5) 617-624
• 35 Rang S, Wolf H, van Montfrans GA, Karemaker JM. Serial assessment of cardiovascular control shows early signs of developing pre-eclampsia. J Hypertens 2004; 22 (2) 369-376