TY - JOUR
T1 - Diagnosis and Monitoring of White Coat Hypertension in Pregnancy
T2 - an ISSHP Consensus Delphi Procedure
AU - ISSHP
AU - Johnson, Sonia
AU - Gordijn, Sanne
AU - Damhuis, Stefanie
AU - Ganzevoort, Wessel
AU - Brown, Mark
AU - von Dadelszen, Peter
AU - Magee, Laura A.
AU - Khalil, Asma
N1 - Funding Information:
We would like to thank our experts for participation in our Delphi procedure*: A. C. Staff (Norway), A. Mohan (United Kingdom), A. Vivekanand (India), A. Henry (Australia), A. Shennan (United Kingdom), A. Martin (Australia), A. Kroushev (Australia), B. Wiltshire (United Kingdom), B. Lewis (United States), C. Foster (Canada), C. Ballesteros (Mexico), C. Sammartino (Australia), D. Kanter (United States), D. Meneni (United Kingdom), D. Thierry (France), D. Schiembach (Germany), D. Graham (Australia), C. Ayyavoo (India), J. Lykke (Denmark), P. Ajit (India), J. Kannan (India), SG. Mandrupkar (India), P. Desai (India), S. Kumari (India), S. Tarakeswari (India), M. Druzin (United States), V. Lahade (India), T. Easterling (United States), L Van Eerden (Netherlands), E. Tsigas (United States), E. Rey (Canada), EYS. Huning (Australia), F. Ouradou (Canada), F Prefumo (Italy), F. Lamb (United Kingdom), F. Audibert (Canada), G. Eastabrook (Canada), G. Ramsay (Canada), G. Davis (Australia), H Strevens (Sweden), H. Watson (United Kingdom), H Goodall (United Kingdom), H. Muijsers (Netherlands), H. Metoki (Japan), H. Stepan (Germany), H. Sikele (Ireland, Republic), H. Seki (Japan), L. Huishu (China), H Hyodo (Japan), I. Forbes (Australia), T Iriyama (Japan), J. Higgins (Ireland, Republic), J. Walker (United Kingdom), J. Cresswell (United Kingdom), J. Waugh (New Zealand), J. Thornton (United Kingdom), J. Hyett (Australia), J. Said (Australia), J Tukur (Nigeria), J. Delgado (Spain), J. Ormandy (New Zealand), K Tran (Canada), K. Leslie (United Kingdom), K. Harding (United Kingdom), K. Tucker (United Kingdom), Mr Keiemi (Japan), K. Matsubara (Japan), K Hodson (United Kingdom), Ms Keweller (United Kingdom), H. Suzuki (Japan), K Macleod (United Kingdom), K. Palmer (Australia), L De Oliveira (Brazil), L. Page (United Kingdom), L. Pealing (United Kingdom), L. Marozio (Italy), L. Mackillop (United Kingdom), M Vasiliou (Canada), E. Kalafat (Turkey), M Bicho (Portugal), M Kuehnert (Germany), M Lynch (United Kingdom), M Lovotti (Italy), M Cauldwell (United Kingdom), M Coleman (United Kingdom), M Jose (Australia), M Mahone (Canada), M Van Oostwaard (Netherland), A Mito (Japan), M Mesquita (Brazil), N Sauve (Canada), N Patrascu (Romania), N Sass (Brazil), N Kametas (United Kingdom), T Ohmary-Nakanishi (Japan), A Ohkuchi (Japan), O. Irtyuga (Russia), P Lan (Australia), A Perales (Spain), P Wein (Australia), R Akolekar (United Kingdom), R Geirsson (Iceland), R Janos (Hungary), R Aardenburg (Netherlands), S Lowe (Australia), M Salazar (Argentina), S Brennecke (Australia), S Rana (United States), S Rengaraj (India), S. Choudhury (India), S Jesudason (Australia), S Gudi (India), K Sortey (India), S Prabhaharan (Australia), T Firoz (United States), Ms Thekhots (Australia), V Thobbi (India), U Pecks (Germany), V Lee (Australia), V Chulkov (Russia), Vl S Chulkov (Russia), W Chan (Canada), W Espeche (Argentina), Z Khodjaeva (Russia). We would also like to acknowledge the organisations that distributed our survey and for encouraging international collaboration: World Gestosis Organization, MacDonald Obstetric Medicine Society, Society of Obstetric Medicine of Australia and New Zealand (SOMANZ), International Society of Obstetric Medicine (ISOM), North American Society of Obstetric Medicine (NASOM), and all national societies that distributed this work among their committees such as the Japanese Society for the Study of Hypertension in Pregnancy (JSSHP). *Full participation is acknowledged, with consent.
Publisher Copyright:
© 2022 American Heart Association, Inc.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - BACKGROUND: There is no accepted definition or standardized monitoring for white coat hypertension in pregnancy. This Delphi procedure aimed to reach consensus on out-of-office blood pressure (BP) monitoring, and white coat hypertension diagnostic criteria and monitoring. METHOD: Relevant international experts completed three rounds of a modified Delphi questionnaire. For each item, the predefined cutoff for group consensus was ≥70% agreement, with 60% to 70% considered to warrant reconsideration at the subsequent round, and <60% considered insufficient to warrant consideration. RESULTS: Of 230 experts, 137 completed the first round and 114 (114/137, 83.2%) completed all three. For out-of-office BP monitoring, there was consensus that home BP monitoring (HBPM) should be chosen; instructions given, pairs of BP values taken, opportunity given for women to qualify values they do not regard as valid, and BP considered evaluated when ≥25% of values are above a cutoff. For HBPM, BP should be taken at least 2 to 3 d/wk, at minimum in the morning; however, many factors may affect frequency and timing. Experts endorsed a clinic BP <140/90 mm Hg as normal. While not reaching consensus, most agreed that HBPM values should be lower than clinic BP. Among those, HBPM <135/85 mm Hg was considered normal. There was consensus that white coat hypertension warrants: HBPM at least 1 d/wk before 20 weeks, 2 to 3 d/wk after 20 weeks or if persistent hypertension develops, and symptom monitoring (ie, headache, visual symptoms, and right upper quadrant/epigastric pain). CONCLUSIONS: Consensus-based diagnostic criteria and monitoring strategies should inform clinical care and research, to facilitate evaluation of out-of-office BP monitoring on pregnancy outcomes.
AB - BACKGROUND: There is no accepted definition or standardized monitoring for white coat hypertension in pregnancy. This Delphi procedure aimed to reach consensus on out-of-office blood pressure (BP) monitoring, and white coat hypertension diagnostic criteria and monitoring. METHOD: Relevant international experts completed three rounds of a modified Delphi questionnaire. For each item, the predefined cutoff for group consensus was ≥70% agreement, with 60% to 70% considered to warrant reconsideration at the subsequent round, and <60% considered insufficient to warrant consideration. RESULTS: Of 230 experts, 137 completed the first round and 114 (114/137, 83.2%) completed all three. For out-of-office BP monitoring, there was consensus that home BP monitoring (HBPM) should be chosen; instructions given, pairs of BP values taken, opportunity given for women to qualify values they do not regard as valid, and BP considered evaluated when ≥25% of values are above a cutoff. For HBPM, BP should be taken at least 2 to 3 d/wk, at minimum in the morning; however, many factors may affect frequency and timing. Experts endorsed a clinic BP <140/90 mm Hg as normal. While not reaching consensus, most agreed that HBPM values should be lower than clinic BP. Among those, HBPM <135/85 mm Hg was considered normal. There was consensus that white coat hypertension warrants: HBPM at least 1 d/wk before 20 weeks, 2 to 3 d/wk after 20 weeks or if persistent hypertension develops, and symptom monitoring (ie, headache, visual symptoms, and right upper quadrant/epigastric pain). CONCLUSIONS: Consensus-based diagnostic criteria and monitoring strategies should inform clinical care and research, to facilitate evaluation of out-of-office BP monitoring on pregnancy outcomes.
KW - blood pressure
KW - consensus
KW - gestational age
KW - headache
KW - hypertension
KW - preeclampsia
KW - pregnancy
UR - http://www.scopus.com/inward/record.url?scp=85128489078&partnerID=8YFLogxK
U2 - 10.1161/HYPERTENSIONAHA.121.18356
DO - 10.1161/HYPERTENSIONAHA.121.18356
M3 - Article
C2 - 35263999
AN - SCOPUS:85128489078
SN - 0194-911X
VL - 79
SP - 993
EP - 1005
JO - Hypertension (Dallas, Tex. : 1979)
JF - Hypertension (Dallas, Tex. : 1979)
IS - 5
ER -