EUROMEDICA  Hanover 6-7  Juni 2008	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover Russian Academy of Natural Sciences, Moscow

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A one time examination of blood circulation parameters do not provide a full picture of their temporarily dynamics especially at night and early morning hours thus affecting diagnostics of pathological conditions and indication of antihypertensive therapy.

Objective. To evaluate the possibility of conducting a 24-hour monitoring of hemodynamic properties with the help of an apparatus for a prolonged control over arterial pressure (AP) based on an oscilometric way of AP measuring in pregnant women and to determine a clinical significance of this method.

Material and methods. 282 pregnant women aged between 17 - 43 years during pregnancy from 4 - 41 weeks were investigated, among them 68 women with chronic hypertension, 60 women with gestational arterial hypertension and 154 patients with normal AP level. A 24-hour arterial pressure monitor BPLab® (Russia) was used. We had tested this apparatus in accordance with International Protocol ESH 2001 in a group of 33 women with different pregnancy due dates. The device complies fully with the requirements of the above mentioned document and can be recommended to a wide application in such patients. AP was registered with intervals of 30 minutes during waking and 60 minutes during sleep. Using the data of AP monitoring and sphygmogram the following parameters were calculated on the Bremser-Ranke formula: stroke volume (SV), minute volume (MV), stroke index (SI), cardiac index (CI), general peripheral vascular resistance (GPVR) modified by Savitsky, Grollman, Poiseuille. Later on they were compared to corresponding hemodynamic properties obtained through echocardiography performed simultaneously to the monitoring (correlation coefficient between stroke volume data derived from echocardiography and calculated with our method was 0,8 in B-mode and 0,7 in D-mode at р < 0,05).

Results. The hemodynamic properties in pregnant women obtained through one time measurement differed from the monitoring data. The deviation ranged between 3,2% and 10,8% for physiologically developing pregnancies and between 2,4% and 14,6% in women with AH. One time hemodynamic data reported (р <0,05) authentically higher AP parameters (systolic AP, diastolyc AP, average hemodynamic pressure) and were lower for SV, SI, MV, CI in comparison to their average assessment. It was revealed that in women with AH the proportion of unfavorable for pregnancy hyper- and hypokinetic types of blood flow increased in the third trimester from 18% up to 29% and 21% correspondingly. Acceleration of pump function of the heart (increase of SV, SI, MV, SI, CI at hyperkinetic type) and reduction of heart work (decrease of the mentioned data at hypokinetic type) in comparison with equisetic type of hemodynamics. Such modifications in blood circulation parameters raise the risk of vascular complications for mother and fetus. In physiological pregnancies GPVR was reduced at night, in the patients with AH - increased. In AH pregnancies average daily parameters of blood circulation were not subject to sharp deviations, however, raise in partial pressure was observed that might be regarded as an unfavorable factor.

Therefore oscillometric devices for 24-hour monitoring of arterial pressure can be used to determine a 24 hour profile of circulation parameters. It will enable to define a type of hemodynamics and to forecast unfavorable hemodynamic changes for mother and fetus and to correct them.