Abstract Details

Title Blood Pressure Variability as a Marker of Sympathetic Hyperreactivity in Postpartum Patients with Preeclampsia, with and without Chronic Hypertension

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P2 - Poster Session 2 (8:00 AM-9:00 AM)

Poster/Presentation
Number 7-003

Objective Compare blood pressure variability (BPV) between postpartum patients with preeclampsia (PE) and patients with preeclampsia superimposed on chronic hypertension (siPE).

Background Preeclampsia, a multi-organ system hypertensive syndrome complicating pregnancy, is associated with sympathetic hyperreactivity. BPV reflects a component of sympathetic noradrenergic activity and, when coupled with impaired cerebral autoregulation, increases susceptibility to cerebral hypo- or hyper-perfusion. siPE is associated with a higher stroke risk than PE. Data are limited regarding autonomic function in PE during the postpartum period, when stroke risk is highest. We hypothesized that postpartum patients with siPE have higher BPV compared to those with PE.

Design/Methods We recruited postpartum patients with PE and siPE and continuously measured mean arterial blood pressure (MAP) using finger plethysmography for up to 24 hours. We converted MAP data to the frequency domain using a Fourier Transform. Low frequency (LF, 0.04-0.15 Hz) signals, associated with sympathetic noradrenergic activity, were isolated and transformed to a normal distribution using a power ladder. We averaged frequency-domain BPV every hour and over the entire monitoring period for each patient using spectral analysis. We compared average and hourly BPV using repeated measures ANOVA between those with PE and siPE.

Results We analyzed data from 23 patients (total 295.8 hours). Median monitoring time was 11.7 hours (IQR 5.2 – 19.5). Nine (39%) patients had siPE. Total LF BPV was non-significantly lower in those with siPE compared to PE (4.62 mmHg² vs. 7.31 mmHg², P = 0.098), as was hourly LF BPV (P = 0.139).

Conclusions Contrary to our hypothesis, patients with siPE did not have higher LF BPV than those with PE, suggesting similar sympathetic activity and autonomic function in the postpartum period. Further studies with larger sample sizes should correlate sympathetic activity and autonomic function to clinical risk and mechanism of neurovascular injury in PE and siPE.

Authors/Disclosures
Noora C. Haghighi, MS PRESENTER	Miss Haghighi has nothing to disclose.
Michael Kirschner	Mr. Kirschner has nothing to disclose.
Helen Woolcock	Miss Woolcock has nothing to disclose.
Leonidas Taliadouros	Mr. Taliadouros has nothing to disclose.
Pedro Castro, MD, PhD	Prof. Castro has nothing to disclose.
Whitney A. Booker, MD	Dr. Booker has nothing to disclose.
Natalie Bello (Cedars-Sinai Medical Center)	Natalie Bello has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for CRF. The institution of Natalie Bello has received research support from NIH.
Nils Petersen, MD (Yale University)	The institution of Dr. Petersen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Silkroad Medical. Dr. Petersen has received research support from NIH.
Eliza C. Miller, MD (University of Pittsburgh)	Dr. Miller has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for medical malpractice cases. The institution of Dr. Miller has received research support from National Institutes of Health. Dr. Miller has a non-compensated relationship as a member of ASA Advisory Council with American Heart Association/American Stroke Association that is relevant to AAN interests or activities.

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