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[Strict treatment of hypertension during pregnancy: safe but not obviously better]

Jeanine E Roeters van Lennep1, J J Hans Duvekot

  • 1Erasmus MC, Rotterdam.

Nederlands Tijdschrift Voor Geneeskunde
|June 11, 2015
PubMed

Insights

Tight blood pressure control during pregnancy is safe for newborns but does not improve maternal outcomes. The Control of Hypertension In Pregnancy Study (CHIPS) provides key insights into managing hypertension in pregnancy.

Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Clinical Trials

Background:

  • Hypertension in pregnancy, encompassing both pre-existing and gestational hypertension, presents distinct pathophysiological characteristics.
  • Current Dutch guidelines address pre-existing and gestational hypertension separately, highlighting the need for nuanced management strategies.
  • The Control of Hypertension In Pregnancy Study (CHIPS) investigated the effects of tight versus usual blood pressure control in pregnant women with hypertension.

Purpose of the Study:

  • To evaluate the safety and efficacy of tight blood pressure control in pregnant women with hypertension regarding neonatal and maternal outcomes.
  • To assess whether tight blood pressure control improves predefined maternal composite outcomes compared to usual control.
  • To analyze the impact of the CHIPS trial findings on existing clinical guidelines for hypertension in pregnancy.

Main Methods:

  • The CHIPS trial enrolled pregnant women diagnosed with hypertension.
  • Participants were randomized to either tight or usual blood pressure control targets.
  • Neonatal outcomes and a composite maternal outcome were the primary endpoints.

Main Results:

  • Tight blood pressure control was found to be safe for neonatal outcomes.
  • No significant improvement was observed in the predefined maternal composite outcome with tight control.
  • The study's primary neonatal endpoint, including 'higher than usual neonatal care,' was considered broadly defined.

Conclusions:

  • While safe for neonates, tight blood pressure control in pregnancy did not demonstrate a benefit for maternal composite outcomes in the CHIPS trial.
  • The study's findings may not directly influence current Dutch guidelines due to population heterogeneity (pre-existing vs. gestational hypertension) and endpoint definition.
  • Further research with refined endpoints combining major maternal and neonatal comorbidities is warranted for greater clinical relevance.

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