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Pulse Pressure and Adverse Maternal and Perinatal Outcomes in Patients With Mild Chronic Hypertension During
Samantha L Martin1, Justin M Leach1, Rachel Sinkey1
1Department of Obstetrics and Gynecology, the Center for Women's Reproductive Health, and the Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; the Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, and the Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina; the Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, the Department of Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, the Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, and the Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, Pennsylvania; the Department of Obstetrics and Gynecology, University of Texas at Houston, and the Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, the Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, and the Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas; HCA Healthcare and HCA Research Institute, Nashville, Tennessee; Maternal Fetal Care Center, Division of Fetal Medicine & Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; the Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; the Department of Obstetrics and Gynecology, MetroHealth/Case Western University, Cleveland, the Department of Obstetrics and Gynecology, The Ohio State University, Columbus, and the Division of Maternal-Fetal Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; the Department of Obstetrics and Gynecology, Indiana University, Indianapolis, Indiana; the Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah; the Department of Obstetrics and Gynecology, Ochsner Health, and the Department of Obstetrics & Gynecology, Tulane University, New Orleans, Louisiana; the Department of Obstetrics and Gynecology, University of Wisconsin-Madison, and the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin; the Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri; the Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi; the Department of Obstetrics and Gynecology, Robert Wood Johnson Medical School, Rutgers University, Brunswick, and the Department of Obstetrics, Gynecology and Reproductive Health, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey; the Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado; the Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia; the Department of Obstetrics and Gynecology, NewYork Presbyterian-Queens Hospital, Flushing, New York; the Department of Obstetrics and Gynecology, Stanford University, Stanford, California; the Oregon Health & Science University, Portland, Oregon; the Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas; the Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas; and the Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina.
Objective:
To evaluate associations among antepartum pulse pressure and maternal and perinatal outcomes in women with mild chronic hypertension.
Methods:
Secondary analysis of the CHAP (Chronic Hypertension and Pregnancy) trial, an open-label randomized controlled trial of antihypertensives (vs none) for mild chronic hypertension (blood pressure below 160/105 mm Hg). Patients without pulse pressure information or outcomes were excluded. The exposure was mean pulse pressure using clinic measurements after enrollment but before delivery, and the primary analysis assessed whether mean pulse pressure was associated with an adverse composite outcome. This composite included preeclampsia with severe features, medically indicated preterm birth (PTB) before 35 weeks of gestation, placental abruption or fetal or neonatal death, and small-for-gestational-age (SGA) birth weight. Logistic regression models were adjusted for randomization assignment.
Results:
Two thousand three hundred twenty-five patients were eligible. The mean (SD) pulse pressure among patients was 50.2 (7.9) mm Hg. Increasing mean antepartum pulse pressure was associated with an increasing frequency of the adverse composite outcome (adjusted odds ratio [aOR] per 5 mm Hg 1.1; 95% CI, 1.0-1.2), preeclampsia with severe features (aOR 1.2; 95% CI, 1.0-1.1), and indicated PTB before 35 weeks of gestation (aOR 1.1; 95% CI, 1.0-1.2). Conversely, increasing pulse pressure was associated with decreasing rates of SGA birth weight below the 5th percentile (aOR 0.9; 95% CI, 0.9-1.0) but was not associated with SGA birth weight below the 10th percentile (aOR 0.9; 95% CI, 0.9-1.0).
Conclusion:
Increasing pulse pressure was modestly associated with an adverse composite, specifically preeclampsia with severe features and indicated PTB before 35 weeks of gestation, but it was negatively associated with SGA birth weight less than the 5th percentile. The role of antepartum pulse pressure in reducing adverse pregnancy outcomes in patients with chronic hypertension should be further investigated.
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