Diagnosis and Monitoring of White Coat Hypertension in Pregnancy: an ISSHP Consensus Delphi Procedure

ISSHP, Sonia Johnson, Sanne Gordijn, Stefanie Damhuis, Wessel Ganzevoort, Mark Brown, Peter von Dadelszen, Laura A Magee, Asma Khalil

    Research output: Contribution to journalArticleAcademicpeer-review

    Abstract

    BACKGROUND: There is no accepted definition or standardized monitoring for white coat hypertension in pregnancy. This Delphi procedure aimed to reach consensus on out-of-office blood pressure (BP) monitoring, and white coat hypertension diagnostic criteria and monitoring.

    METHOD: Relevant international experts completed three rounds of a modified Delphi questionnaire. For each item, the predefined cutoff for group consensus was ≥70% agreement, with 60% to 70% considered to warrant reconsideration at the subsequent round, and <60% considered insufficient to warrant consideration.

    RESULTS: Of 230 experts, 137 completed the first round and 114 (114/137, 83.2%) completed all three. For out-of-office BP monitoring, there was consensus that home BP monitoring (HBPM) should be chosen; instructions given, pairs of BP values taken, opportunity given for women to qualify values they do not regard as valid, and BP considered evaluated when ≥25% of values are above a cutoff. For HBPM, BP should be taken at least 2 to 3 d/wk, at minimum in the morning; however, many factors may affect frequency and timing. Experts endorsed a clinic BP <140/90 mm Hg as normal. While not reaching consensus, most agreed that HBPM values should be lower than clinic BP. Among those, HBPM <135/85 mm Hg was considered normal. There was consensus that white coat hypertension warrants: HBPM at least 1 d/wk before 20 weeks, 2 to 3 d/wk after 20 weeks or if persistent hypertension develops, and symptom monitoring (ie, headache, visual symptoms, and right upper quadrant/epigastric pain).

    CONCLUSIONS: Consensus-based diagnostic criteria and monitoring strategies should inform clinical care and research, to facilitate evaluation of out-of-office BP monitoring on pregnancy outcomes.

    Original languageEnglish
    Pages (from-to)993-1005
    Number of pages13
    JournalHypertension (Dallas, Tex. : 1979)
    Early online date10-Mar-2022
    DOIs
    Publication statusPublished - 1-May-2022

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