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Published on: January 7, 2018
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.
Objective:
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.
Methods:
We conducted a planned secondary analysis of CHAP (Chronic Hypertension and Pregnancy), an open label, multicenter, randomized controlled trial. Participants with mean BP below 140/90 mm Hg were grouped as below 130/80 mm Hg compared with 130-139/80-89 mm Hg by averaging postrandomization clinic BP throughout pregnancy. The primary composite outcome was preeclampsia with severe features, indicated preterm birth before 35 weeks of gestation, placental abruption, or fetal or neonatal death. The secondary outcome was small for gestational age (SGA).
Results:
Of 2,408 patients in CHAP, 2,096 met study criteria; 1,328 had mean BP 130-139/80-89 mm Hg and 768 had mean BP below 130/80 mm Hg. Participants with mean BP below 130/80 mm Hg were more likely to be older, on antihypertensive medication, in the active treatment arm, and to have lower BP at enrollment. Mean clinic BP below 130/80 mm Hg was associated with lower frequency of the primary outcome (16.0% vs 35.8%, adjusted relative risk 0.45; 95% CI 0.38-0.54) as well as lower risk of severe preeclampsia and indicated birth before 35 weeks of gestation. There was no association with SGA.
Conclusion:
In pregnant patients with mild chronic hypertension, mean BP below 130/80 mm Hg was associated with improved pregnancy outcomes without increased risk of SGA.
Clinical Trial Registration:
ClinicalTrials.gov , NCT02299414.
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