Definitions of hypertension and proteinuria
Measurement of blood pressure and definition of hypertension
Blood pressure (BP) should be measured thrice, with the average of the second and third values
taken as the BP for the visit [1,2]. BP may be measured in the office (by auscultatory or automated
methods) or outside the office (by ambulatory blood pressure monitoring (ABPM) or home blood
pressure monitoring (HBPM)) [1]. In ABPM, BP is measured serially using an automated device over
24 h or repeatedly in a day unit. HBPM is done by the woman using an automated device, with
duplicate measurements taken at least twice daily over several days.
Although pregnant women and their care providers prefer HBPM to ABPM, data are insufficient to
guide choice. Patients require education about devices acceptable for use in pregnancy, monitoring
procedures and the BP threshold for alerting maternity care providers. If women are unable to access
pregnancy-validated devices, clinicians should compare contemporaneous HBPM and office readings.
Hypertension in pregnancy is an office/hospital systolic blood pressure (sBP) 140 mmHg and/or
diastolic blood pressure (dBP) 90 mmHg, or ABPM or HBPM sBP 135 and/or dBP85 mmHg [1]. Severe
hypertension is sBP 160 mmHg and/or dBP 110 mmHg, confirmed after 15 min at the same visit.
Hypertension may reflect a situational rise, the ‘white-coat’ effect or early pre-eclampsia [3,4]. Up to 70%
of womenwith office hypertension have normal BP on subsequent measurements on the same visit, or by
ABPM or HBPM [5]. The ‘white-coat’ effect is observed when BP is 140/90 mmHg in the office but