Applying new blood pressure management techniques to Pregnancy-related Hypertension

Background: Pregnancy-related hypertension remains the most common medical complication affecting pregnancy. Central to the diagnosis and management of this group of disorders remains the measurement of blood pressure. Within the general adult population newer methods of measurement and management of blood pressure have been applied to improve clinical outcomes with good effect. The aim of this thesis is to apply these newer techniques into the management of pregnancy-related hypertension in order to improve both clinical outcomes and our understanding of its aetiology and pathogenesis. Methods: I performed a number of clinical studies and analyses examining the effect of the newer techniques both during pregnancy and in the early postpartum period. I examined the use of automated blood pressure measuring devices and home blood pressure measurement in guiding management. In addition, I examined the utility of pulse-wave analysis in early pregnancy prediction of the development of pregnancy-related hypertension. Finally, I assessed the clinical effects of the early prescription of low-dose aspirin on the clinical severity of pre-eclampsia. Results: Automated blood pressure measuring devices and home blood pressure measurement were found to be clinically useful in the management of pregnancy-related hypertension. Pulse-wave analysis was not found to be clinically useful in the early pregnancy prediction for the development of pregnancy-related hypertension. Finally, aspirin was not found to affect the clinical severity of pre-eclampsia requiring delivery after thirty-four weeks gestation. Conclusion: There were varying levels of success in regards to the application of the new techniques. Despite this, we found that these newer techniques provide clinicians with future opportunities to improve clinical outcomes, whilst also raising further questions about the pathogenesis of this group of disorders that requires further research