TY - CHAP
T1 - Does performance of mean arterial blood pressure for the screening of preeclampsia improve after controlling for the use of anti-hypertensive medication?
AU - Ayis, Salma Ahmed Mohamed
AU - Nzelu, Diane Adenike
AU - Dumitrascu-Biris, Dan
AU - Cordina, Mark
AU - Kametas, Nikos
PY - 2017
Y1 - 2017
N2 - Question: Mean arterial pressure (MAP) is a useful biomarker for
the screening of preeclampsia (PE). However, MAP, a function of cardiac
output and peripheral resistance, is dependent on other maternal
characteristics and, for its effective use in screening, these need
to be taken into account. One such characteristic is the use of antihypertensive
medication.
The aim of our study was to evaluate the impact of the use of
anti-hypertensive medication on the performance of MAP as a
screening tool for PE in pregnant women with chronic hypertension
or a history of gestational hypertension.
Methods: A retrospective study was conducted on women with
chronic hypertension (N = 478) and normotensive women with a
history of gestational hypertension (N = 511) who booked with the
Antenatal Hypertension Clinic, Kings College Hospital, London,
between 2009–2016. Blood pressure was measured repeatedly antenatally
using an automated device validated for use in pregnancy
and PE. The more updated International Society for the Study of
Hypertension in Pregnancy (ISSHP)-2014 definition of PE was used.
We constructed probit Receiver Operating Characteristic Curves
(ROC) models to determine the predictive capacity of MAP in women
taking anti-hypertensive medication and in those who were not.
Wald tests of the null hypothesis that the two ROC curves are equal
at different false-positive rates were performed. Age and medication
use were taken into account in the comparisons.
Results: The area under the curves (AUC) for the prediction of PE
(p = <0.001) was 0.63 (95%CI: 0.59–0.68) and 0.75 (95% CI: 0.71–
0.79) for women taking medication and those who were not, respectively.
The AUC for the predication of renal dysfunction (p = 0.11)
was 0.63 (95% CI: 0.58–0.68) and 0.70 (95% CI: 0.63–0.78) for women
taking medication and those who were not, respectively. There were
no differences found between the AUC for the prediction of FGR and
liver dysfunction. The estimates were adjusted for age.
Conclusion: The ability of MAP to predict PE and renal dysfunction
is significantly improved by controlling for the use of antihypertensive
medication in a high-risk pregnant population.
AB - Question: Mean arterial pressure (MAP) is a useful biomarker for
the screening of preeclampsia (PE). However, MAP, a function of cardiac
output and peripheral resistance, is dependent on other maternal
characteristics and, for its effective use in screening, these need
to be taken into account. One such characteristic is the use of antihypertensive
medication.
The aim of our study was to evaluate the impact of the use of
anti-hypertensive medication on the performance of MAP as a
screening tool for PE in pregnant women with chronic hypertension
or a history of gestational hypertension.
Methods: A retrospective study was conducted on women with
chronic hypertension (N = 478) and normotensive women with a
history of gestational hypertension (N = 511) who booked with the
Antenatal Hypertension Clinic, Kings College Hospital, London,
between 2009–2016. Blood pressure was measured repeatedly antenatally
using an automated device validated for use in pregnancy
and PE. The more updated International Society for the Study of
Hypertension in Pregnancy (ISSHP)-2014 definition of PE was used.
We constructed probit Receiver Operating Characteristic Curves
(ROC) models to determine the predictive capacity of MAP in women
taking anti-hypertensive medication and in those who were not.
Wald tests of the null hypothesis that the two ROC curves are equal
at different false-positive rates were performed. Age and medication
use were taken into account in the comparisons.
Results: The area under the curves (AUC) for the prediction of PE
(p = <0.001) was 0.63 (95%CI: 0.59–0.68) and 0.75 (95% CI: 0.71–
0.79) for women taking medication and those who were not, respectively.
The AUC for the predication of renal dysfunction (p = 0.11)
was 0.63 (95% CI: 0.58–0.68) and 0.70 (95% CI: 0.63–0.78) for women
taking medication and those who were not, respectively. There were
no differences found between the AUC for the prediction of FGR and
liver dysfunction. The estimates were adjusted for age.
Conclusion: The ability of MAP to predict PE and renal dysfunction
is significantly improved by controlling for the use of antihypertensive
medication in a high-risk pregnant population.
M3 - Conference paper
VL - 9 (2017)
SP - 52
EP - 53
BT - / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health
ER -