Heart rate and blood pressure chronomes during and after pregnancy

Whereas conventional time-unspecified single measurements of blood pressure and heart rate may mislead, influenced as they are, among other factors, by the individual's emotional state, position, diet and external stimuli generally, the chronobiologic evaluation of predictable variability in these physiologic variables assesses early cardiovascular disease risk in pregnancy by (a) the use of fully ambulatory devices and (b) the proper processing of the time series thus obtained. We have used this approach to quantify changes in 24-h synchronized circadian characteristics of cardiovascular variables in two consecutive pregnancies of a clinically healthy woman. The results were then compared with those obtained from data sampled after the second pregnancy. Blood pressure and heart rate were automatically monitored, at 1-h intervals, each time for at least 48 consecutive hours, and for a total of 76 days of monitoring in each pregnancy. Circadian parameters of those circulatory variables were computed for each 48-h profile of measurements by the least-squares fit of a 24-h cosine curve. Regression analysis of parameters thus obtained revealed patterns of variation of circadian rhythm-adjusted means and amplitudes with gestational age. In both pregnancies, the predictable variability of the circadian rhythm-adjusted mean of blood pressure can be approximated by a second-order polynomial model on gestational age: a steady linear decrease in systolic, mean arterial and diastolic blood pressures up to the 22nd week of pregnancy is followed by an increase up to the day of delivery. This pattern of variation is not found for data similarly sampled during non-pregnancy on the same woman. This longitudinal study confirms and extends to ambulatory everyday life conditions the predictable pregnancy-associated variability in blood pressure and heart rate and also allows the establishment of prediction and confidence limits for cardiovascular parameters in a healthy pregnancy.