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The circadian rhythm of blood pressure during pregnancy
Objective:
To review the literature on the circadian rhythm of blood pressure during pregnancy.
Data Sources:
Computerized searches on MEDLINE, CINAHL, and MIRLYN.
Study Selection:
Selected studies from 1 969 to 1997 were evaluated.
Data Extraction:
Data were extracted and information was organized under the following areas: definition of and the interconnection between circadian rhythm and blood pressure; the circadian variability of blood pressure throughout the trimesters; the patterns of the circadian rhythm of blood pressure in pregnancies defined as normal and those complicated by chronic hypertension and preeclampsia; and clinical implications.
Data Synthesis:
The circadian rhythm of blood pressure in pregnancy is the same as in the non-pregnant state, with a nocturnal decrease, especially during sleep. In patients with chronic hypertension, the nocturnal fall in blood pressure may be steeper. Patients with mild preeclampsia may experience a less pronounced nocturnal decrease in blood pressure. Patients with severe preeclampsia may display a reversed circadian rhythm, with no decrease and/or an increase in nocturnal blood pressure.
Conclusions:
The patterns of the circadian rhythm of blood pressure during normal pregnancy and pregnancies complicated by chronic hypertension and preeclampsia warrant consideration when monitoring patients and implementing management plans.