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