Cardiometabolic profile and 24-hour blood pressure monitoring parameters in pregnant women with white coat hypertension

   Objective: to perform a comparative assessment of cardiometabolic parameters and 24-h blood pressure monitoring indicators in pregnant women with white-coat hypertension and normal blood pressure.

   Materials and methods: this prospective cohort study included 88 pregnant women aged 18–44 years: group 1 (study group) – 44 women with white coat hypertension (aged 32 ± 5.7 years); group 2 (comparison group) – 44 women with normal blood pressure (aged 28 ± 5.9 years).

   Results: the most significant differences between groups 1 and 2 were observed in serum glucose, low-density lipoprotein cholesterol, and uric acid. In assessing cardiometabolic risk factors, significant differences were found only in the frequency of abdominal obesity. Only pregnant women with white-coat hypertension had a history of preeclampsia and gestational hypertension. The mean daytime and nighttime systolic blood pressure (SBP) and diastolic blood pressure (DBP), daytime variability of SBP, daytime time index of SBP, daytime and nighttime time index of DBP, daytime mean heart rate, the rate of morning rise of SBP and DBP, as well as a high frequency of non-dippers were significantly higher in pregnant women in group 1 compared to group 2.

   Conclusion: 24-h blood pressure monitoring up to 20 weeks of pregnancy allows not only recognition of white-coat hypertension but also identification of a high-risk group for more careful monitoring of pregnant women with this hypertension phenotype.

1. Stryuk R.I., Bunin Yu.A., Guryeva V.M., Irtyuga O.B., Kokov L.S., Kolomatskaya O.E., et al. Diagnostics and treatment of cardiovascular diseases during pregnancy 2018. National recommendations. Russian Journal of Cardiology. 2018;23(3):91-134. (In Russ.) DOI: 10.15829/1560-4071-2018-3-91-134

2. Magee L.A., Brown M.A., Hall D.R., Gupte S., Hennessy A., Karumanchi S.A., et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens. 2022;27:148-169. DOI: 10.1016/j.preghy.2021.09.008

3. Chulkov V.S., Martynov A.I., Kokorin V.A. Arterial hypertension in pregnant women: controversial issues of national and international recommendations. Russian Journal of Cardiology. 2020;25(S4):46-54. (In Russ.) DOI: 10.15829/1560-4071-2020-4181

4. Roberts J.M., Countouris M. White Coat Hypertension in Pregnancy: The Challenge of Combining Inconsistent Data. Hypertension. 2020;76(1):35-37. DOI: 10.1161/HYPERTENSIONAHA.120.15056

5. Chulkov V.S., Nikolenko E.S., Chulkov Vl.S. White-coat hypertension in pregnant women. South Russian Journal of Therapeutic Practice. 2022;3(4):25-31. (In Russ.) DOI: 10.21886/2712-8156-2022-3-4-25-31

6. Kobalava Zh.D., Konradi A.O., Nedogoda S.V., Shlyakhto E.V., Arutyunov G.P., Baranova E.I., et al. Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(3):3786. (In Russ.) DOI: 10.15829/1560-4071-2020-3-3786

7. Chulkov V.S., Nikolenko E., Chulkov V., Podzolko A. White-coat hypertension in pregnant women: risk factors, pregnancy outcomes, and biomarkers. Folia Med (Plovdiv). 2023:31;65(4):539-545. DOI: 10.3897/folmed.65.e99159

8. Johnson S., Liu B., Kalafat E., Thilaganathan B., Khalil A. Maternal and Perinatal Outcomes of White Coat Hypertension During Pregnancy : A Systematic Review and Meta-Analysis. Hypertension. 2020;76(1):157-166. DOI: 10.1161/HYPERTENSIONAHA.119.14627

9. Smith P.A., Graham L.N., Mackintosh A.F., Stoker J.B., Mary D.A. Sympathetic neural mechanisms in white-coat hypertension. J Am Coll Cardiol. 2002;40:126–32. DOI: 10.1016/s0735-1097(02)01931-9

10. Rodrigues Â., Barata C., Marques I., Almeida M.C. Diagnosis of White Coat Hypertension and pregnancy outcomes. Pregnancy Hypertens. 2018;14:121-124. DOI: 10.1016/j.preghy.2018.08.452

11. Johnson S., Gordijn S., Damhuis S., Ganzevoort W., Brown M., von Dadelszen P., et al. Diagnosis and Monitoring of White Coat Hypertension in Pregnancy: an ISSHP Consensus Delphi Procedure. Hypertension. 2022;79(5):993-1005. DOI: 10.1161/HYPERTENSIONAHA.121.18356

12. Brown M.A., Mangos G., Davis G., Homer C. The natural history of white coat hypertension during pregnancy. BJOG. 2005;112:601–606. DOI: 10.1111/j.1471-0528.2004.00516.x

13. Mussarat N, Biggio J Jr, Martin J, Morgan J, Tivis R, et al. Masked pregnancy-associated hypertension as a predictor of adverse outcomes. Am J Obstet Gynecol MFM. 2023;5:100976. DOI: 10.1016/j.ajogmf.2023.100976

14. Fang Y., Zuo L., Duan H., Huang C., Wen J., Yang Q., et al. Hypertension phenotypes and adverse pregnancy outcome-related office and ambulatory blood pressure thresholds during pregnancy: a retrospective cohort study. Hypertens Res. 2025;48(1):77-87. DOI: 10.1038/s41440-024-01837-x

15. Chulkov V.S., Gasanov M.Z., Azovtseva O.V., Minina E.Е., Chulkov Vl.S. The role of beta blockers in the treatment of cardiovascular diseases. Meditsinskiy Sovet. 2024;18(16):28–36. (In Russ.). DOI: 10.21518/ms2024-467