The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study)

Author:

Magee Laura A.1,von Dadelszen Peter1,Singer Joel1,Lee Terry1,Rey Evelyne1,Ross Susan1,Asztalos Elizabeth1,Murphy Kellie E.1,Menzies Jennifer1,Sanchez Johanna1,Gafni Amiram1,Helewa Michael1,Hutton Eileen1,Koren Gideon1,Lee Shoo K.1,Logan Alexander G.1,Ganzevoort Wessel1,Welch Ross1,Thornton Jim G.1,Moutquin Jean-Marie1

Affiliation:

1. From the Molecular and Clinical Sciences Research Institute, St. George’s, University of London and St. George’s NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and...

Abstract

To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of “less tight” (target diastolic blood pressure [dBP] 100 mm Hg) versus “tight” control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for >48 hours) and secondary outcomes (serious maternal complications), birth weight <10th percentile, preeclampsia, delivery at <34 or <37 weeks, platelets <100×10 9 /L, elevated liver enzymes with symptoms, maternal length of stay ≥10 days, and maternal readmission before 6 weeks postpartum. Three hundred and thirty-four (34.1%) women in CHIPS developed severe hypertension that was associated with all outcomes examined except for maternal readmission ( P =0.20): CHIPS primary outcome, birth weight <10th percentile, preeclampsia, preterm delivery, elevated liver enzymes (all P <0.001), platelets <100×10 9 /L ( P =0.006), and prolonged hospital stay ( P =0.03). The association between severe hypertension and serious maternal complications was seen only in less tight control ( P =0.02). Adjustment for preeclampsia (464, 47.3%) did not negate the relationship between severe hypertension and the CHIPS primary outcome ( P <0.001), birth weight <10th percentile ( P =0.005), delivery at <37 ( P <0.001) or <34 weeks ( P <0.001), or elevated liver enzymes with symptoms ( P =0.02). Severe hypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preeclampsia co-occurrence. Clinical Trial Registration— URL: http://pre-empt.cfri.ca/ . Unique identifier: ISRCTN 71416914. URL: https://www.clinicaltrials.gov/ . Unique identifier: NCT01192412.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Internal Medicine

Cited by 184 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3