Perinatal Outcomes Associated With Management of Stage 1 Hypertension

Erin J. Bailey, Alan T.N. Tita, Justin Leach, Kim Boggess, Lorraine Dugoff, Baha Sibai, Kirsten Lawrence, Brenna L. Hughes, Joseph Bell, Kjersti Aagaard, Rodney K. Edwards, Kelly Gibson, David M. Haas, Lauren Plante, Torri D. Metz, Brian M. Casey, Sean Esplin, Sherri Longo, Matthew Hoffman, George R. SaadeJanelle Foroutan, Methodius G. Tuuli, Michelle Y. Owens, Hyagriv N. Simhan, Heather A. Frey, Todd Rosen, Anna Palatnik, Susan Baker, Phyllis August, Uma M. Reddy, Wendy Kinzler, Emily J. Su, Iris Krishna, Nicki Nguyen, Mary E. Norton, Daniel Skupski, Yasser Y. El-Sayed, Dotun Ogunyemi, Zorina S. Galis, Lorie Harper, Namasivayam Ambalavanan, Suzanne Oparil, Hui Chien Kuo, Jeff M. Szychowski, Kara Hoppe

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1395-1404
Number of pages10
JournalObstetrics and Gynecology
Volume142
Issue number6
DOIs
StatePublished - 1 Dec 2023
Externally publishedYes

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