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Perinatal Outcomes Associated With Management of Stage 1 Hypertension
Erin J Bailey1, Alan T N Tita, Justin Leach
1Departments of Obstetrics and Gynecology, University of Wisconsin, Madison, and Medical College of Wisconsin, Milwaukee, Wisconsin, University of Alabama at Birmingham, Birmingham, and University of South Alabama, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel University College of Medicine, Philadelphia, St. Luke's University Health Network, Fountain Hill, and Magee Women's Hospital and University of Pittsburgh, Pittsburgh, Pennsylvania, University of Texas at Houston, Baylor College of Medicine, and Texas Children's Hospital, Houston, UTSouthwestern Medical Center, Dallas, and University of Texas Medical Branch, Galveston, Texas, Columbia University, New York, NYU Langone Hospital-Long Island, Mineola, and NewYork-Presbyterian Queens Hospital, Queens, New York, University of Oklahoma Health Sciences, Oklahoma City, Oklahoma, Indiana University, Indianapolis, Indiana, University of Utah Health, Salt Lake City, Utah, Washington University in St. Louis, St. Louis, Missouri, University of Mississippi Medical Center, Jackson, Mississippi, The Ohio State University, Columbus, Ohio, Rutgers University-Robert Wood Johnson Medical School, New Brunswick, New Jersey, Yale University, New Haven, Connecticut, University of Colorado, Aurora, and Denver Health, Denver, Colorado, Emory University, Atlanta, Georgia, University of California, San Francisco, San Francisco, Stanford University, Palo Alto, and Arrowhead Regional Medical Center, Colton, California, and Beaumont Hospital, Royal Oak, Michigan; the Department of Biostatistics, the Division of Neonatology, Department of Pediatrics, the Division of Cardiovascular Disease, Department of Medicine, and the Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama; MetroHealth System, Cleveland, Ohio; Intermountain Healthcare, Salt Lake City, Utah; Ochsner Baptist Medical Center, New Orleans, Louisiana; Christiana Care Health Services, Newark, Delaware; St. Peter's University Hospital, New Brunswick, New Jersey; Weill Cornell Medicine, New York, New York; Zuckerberg San Francisco General Hospital, San Francisco, California; the Division of Cardiovascular Sciences, NHLBI, Bethesda, Maryland; and the Department of Women's Health, University of Texas at Austin, Austin, Texas.
Maintaining maternal blood pressure (BP) below 130/80 mm Hg in women with mild chronic hypertension is linked to better pregnancy outcomes. This target BP was associated with fewer severe complications and preterm births, without increasing the risk of small for gestational age infants.
Area of Science:
- Obstetrics and Gynecology
- Cardiology in Pregnancy
- Maternal-Fetal Medicine
Background:
- Mild chronic hypertension affects a significant number of pregnancies.
- Current guidelines suggest BP targets for pregnant individuals with hypertension.
- The optimal BP threshold for improved pregnancy outcomes in mild chronic hypertension requires further investigation.
Purpose of the Study:
- To evaluate the association between maternal blood pressure (BP) below 130/80 mm Hg compared with 130-139/80-89 mm Hg and pregnancy outcomes.
- To determine if a lower BP target in mild chronic hypertension improves maternal and fetal health.
- To assess the impact of BP control on composite adverse pregnancy outcomes and fetal growth.
Main Methods:
- Secondary analysis of the Chronic Hypertension and Pregnancy (CHAP) randomized controlled trial.
- Participants with mean BP below 140/90 mm Hg were categorized into two groups: <130/80 mm Hg and 130-139/80-89 mm Hg.
- Primary composite outcome included preeclampsia with severe features, preterm birth before 35 weeks, placental abruption, or fetal/neonatal death; secondary outcome was small for gestational age (SGA).
Main Results:
- Of 2,096 participants, 768 had mean BP <130/80 mm Hg and 1,328 had mean BP 130-139/80-89 mm Hg.
- Mean BP <130/80 mm Hg was associated with a significantly lower frequency of the primary composite outcome (16.0% vs. 35.8%).
- Lower BP target was linked to reduced risk of severe preeclampsia and indicated preterm birth before 35 weeks, with no association found for SGA.
Conclusions:
- In pregnant patients with mild chronic hypertension, achieving a mean BP below 130/80 mm Hg is associated with improved pregnancy outcomes.
- This lower BP target did not increase the risk of small for gestational age infants.
- These findings support a more intensive BP management strategy in pregnant individuals with mild chronic hypertension.
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