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Treatment for Mild Chronic Hypertension during Pregnancy
Alan T Tita1, Jeff M Szychowski1, Kim Boggess1
1From the Department of Obstetrics and Gynecology (A.T.T., W.W.A.), the Center for Women's Reproductive Health (A.T.T., J.M.S., N.A., S.O., G.R.C., W.W.A.), the Department of Biostatistics (J.M.S., G.R.C.), the Division of Neonatology, Department of Pediatrics (N.A.), and the Division of Cardiovascular Disease, Department of Medicine (S.O.), University of Alabama, Birmingham; the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill (K.B.), and the Department of Obstetrics and Gynecology, Duke University, Durham (B.L.H.) - both in North Carolina; the Department of Obstetrics and Gynecology, University of Pennsylvania (L.D.), and the Department of Obstetrics and Gynecology, Drexel University College of Medicine (L.P.), Philadelphia, St. Luke's University Health Network, Fountain Hill (J.B.), and the Department of Obstetrics and Gynecology, Magee Women's Hospital, University of Pittsburgh, Pittsburgh (H.N.S.) - all in Pennsylvania; the Department of Obstetrics and Gynecology, University of Texas (B.S.), and the Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston (K.A.), the Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas (B.C.), the Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston (G.R.S.), and the Department of Women's Health, University of Texas, Austin (L.H.); the Department of Obstetrics and Gynecology, Columbia University (K.L.), Weill Cornell University (P.A.), and the Department of Obstetrics and Gynecology, New York Presbyterian Queens Hospital (D.S.), New York, and the Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola (W.K.) - all in New York; the Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences, Oklahoma City (R.K.E.); MetroHealth System, Cleveland (K.G.); the Department of Obstetrics and Gynecology, Indiana University, Indianapolis (D.M.H.); the Department of Obstetrics and Gynecology, University of Utah (T.M.), and Intermountain Healthcare (S.E.), Salt Lake City; Ochsner Baptist Medical Center, New Orleans (S.L.); Christiana Care Health Services, Newark, DE (M.H.); the Department of Obstetrics and Gynecology, UnityPoint Health-Meriter Hospital/Marshfield Clinic, Madison (K.K.H.), and the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee (A.P.); St. Peters University Hospital (J.F.) and the Department of Obstetrics and Gynecology, Robert Wood Johnson Medical School, Rutgers University (T.R.), New Brunswick, NJ; the Department of Obstetrics and Gynecology, Washington University, St. Louis (M.T.); the Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson (M.Y.O.); the Department of Obstetrics and Gynecology, Ohio State University, Columbus (H.F.); the Department of Obstetrics and Gynecology, University of South Alabama, Mobile (S.B.); the Department of Obstetrics and Gynecology, Yale University, New Haven, CT (U.M.R.); the Department of Obstetrics and Gynecology, University of Colorado, Boulder (E.S.), and the Department of Obstetrics and Gynecology, Denver Health, Denver (N.N.); the Department of Obstetrics and Gynecology, Emory University, Atlanta (I.K.); the Department of Obstetrics and Gynecology, University of California, San Francisco, and Zuckerberg San Francisco General Hospital (M.E.N.), San Francisco, the Department of Obstetrics and Gynecology, Stanford University, Stanford (Y.Y.E.-S.), and the Department of Obstetrics and Gynecology, Arrowhead Regional Medical Center, Colton (D.O.); Beaumont Hospital, Southfield, MI (D.O.); and the Division of Cardiovascular Sciences (Z.S.G.) and the Office of Biostatistics Research (N.L.G.), National Heart, Lung, and Blood Institute, Bethesda, MD.
Treating mild chronic hypertension in pregnancy with a target blood pressure below 140/90 mm Hg improves pregnancy outcomes. This strategy did not increase the risk of small-for-gestational-age birth weight in newborns.
Area of Science:
- Obstetrics and Gynecology
- Cardiology
- Clinical Trials
Background:
- The benefits and safety of treating mild chronic hypertension (BP <160/100 mm Hg) during pregnancy remain uncertain.
- There is a need to determine if targeting BP <140/90 mm Hg reduces adverse pregnancy outcomes without impacting fetal growth.
Purpose of the Study:
- To evaluate the efficacy and safety of targeting a lower blood pressure in pregnant women with mild chronic hypertension.
- To compare pregnancy outcomes between women receiving antihypertensive treatment and those receiving standard care.
Main Methods:
- An open-label, multicenter, randomized trial involving pregnant women with mild chronic hypertension.
- Participants were assigned to an active-treatment group (antihypertensive medications) or a control group (treatment only for severe hypertension).
- Primary outcome: composite of preeclampsia with severe features, preterm birth (<35 weeks), placental abruption, or fetal/neonatal death. Safety outcome: small-for-gestational-age birth weight.
Main Results:
- The incidence of the primary outcome was significantly lower in the active-treatment group (30.2%) compared to the control group (37.0%) (Risk Ratio 0.82).
- No significant difference was observed in the incidence of small-for-gestational-age birth weight between the groups (11.2% vs. 10.4%).
- Active treatment was associated with reduced rates of preeclampsia (24.4% vs. 31.1%) and preterm birth (27.5% vs. 31.4%).
Conclusions:
- Targeting a blood pressure of less than 140/90 mm Hg in pregnant women with mild chronic hypertension improves pregnancy outcomes.
- This strategy is associated with a reduced risk of adverse pregnancy events without increasing the risk of small-for-gestational-age birth weight.
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