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The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an

Laura A Magee1, Peter von Dadelszen2, Joel Singer2

  • 1From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.). LMagee@sgul.ac.uk.

Hypertension (Dallas, Tex. : 1979)
|September 14, 2016
PubMed

Insights

Severe hypertension in pregnancy is a significant risk marker for adverse maternal and perinatal outcomes. This risk persists regardless of blood pressure control strategies or preeclampsia occurrence.

Area of Science:

  • Obstetrics and Gynecology
  • Cardiology
  • Perinatology

Background:

  • Hypertension in pregnancy, including gestational and preexisting forms, affects maternal and fetal well-being.
  • The Control of Hypertension in Pregnancy Study (CHIPS) investigated different blood pressure (BP) control targets.
  • Severe hypertension is a critical clinical sign requiring careful evaluation of associated risks.

Purpose of the Study:

  • To analyze the association between the occurrence of severe hypertension and clinical outcomes in the CHIPS trial.
  • To determine if severe hypertension independently predicts adverse outcomes, adjusting for BP control interventions and baseline factors.

Main Methods:

  • Post-hoc analysis of data from 987 women in the CHIPS trial with nonsevere, nonproteinuric hypertension.
  • Mixed effects logistic regression was used to compare outcomes between women who developed severe hypertension and those who did not.
  • Outcomes included perinatal loss, neonatal care, maternal complications, birth weight, preeclampsia, preterm delivery, and liver enzyme abnormalities.

Main Results:

  • 34.1% of women developed severe hypertension.
  • Severe hypertension was associated with all examined adverse outcomes except maternal readmission.
  • Key associations included the CHIPS primary outcome, low birth weight, preeclampsia, preterm delivery, and elevated liver enzymes (all P<0.001).
  • The link between severe hypertension and adverse outcomes remained significant even after adjusting for preeclampsia.

Conclusions:

  • Severe hypertension serves as an independent risk marker for adverse maternal and perinatal outcomes.
  • These risks are present irrespective of the applied blood pressure control strategy (tight vs. less tight).
  • Clinical vigilance for severe hypertension is crucial for identifying pregnancies at high risk for complications.

Keywords:
antihypertensive therapyhypertensionlabetalolmethyldopapregnancy

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