White coat hypertension in pregnant women: clinical characteristics, changes in the heart, kidney, and blood vessels

Background. Pregnancy is characterized by adaptive changes in the heart, blood vessels and kidneys, which are necessary to meet the increased hemodynamic needs of the fetus, while ensuring mother’s homeostasis. Currently, there is no information about adaptive changes in the cardiovascular system and kidneys in pregnant women with white coat hypertension. Objective. To compare the frequency of cardiometabolic risk factors, changes in the heart, kidney, and blood vessels in pregnant women with white coat hypertension and in pregnant women with normal blood pressure (BP). Design and methods. The study included 88 pregnant women divided into two groups: group 1 (main group) — 44 women with white coat hypertension (aged 32,5 ± 5,7 years) and group 2 (comparison group) — 44 women with normal blood pressure (aged 28,1 ± 5,9 years), p = 0,001. The assessment of clinical factors, 24-hour BP monitoring parameters, structural and functional assessment of the heart, kidneys and blood vessels was carried out. Results. Pregnant women with white coat hypertension had a higher incidence of abdominal obesity and preeclampsia in the previous pregnancy; based on the 24-hour BP monitoring they had higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) during the day and at night, higher SBP variability during the day, higher SBP time index during the day, higher DBP time index during the day and night, higher average heart rate during the day, higher rate of non-dipper profile. They also demonstrated early signs of heart and vessel remodeling accompanied by the initial functional changes in the kidneys compared with pregnant women with normal BP. Conclusion. Pregnant women with white coat hypertension require careful monitoring and assessment of cardiometabolic risk factors, daily BP monitoring till 20 weeks of pregnancy, and a comprehensive assessment of the structural and functional state of target organs in order to make a differential diagnosis with chronic arterial hypertension and predict the risk of its development.

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