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Degree of hypertension control did not affect pregnancy complications
In pregnant women, risk for pregnancy loss, high-level neonatal care and overall maternal complications did not differ based on tight control or less-tight control of hypertension, according to data from the CHIPS trial.
Researchers conducted a trial of 987 pregnant women, 74.6% of whom had pre-existing hypertension, with office diastolic BP 90 mm Hg to 105 mm Hg (85 mm Hg to 105 mm Hg for those assigned antihypertensive medications).
The women were randomly assigned to less-tight hypertension control, with a target diastolic BP of 100 mm Hg, or to tight hypertension control, with a target diastolic BP of 85 mm Hg.
The composite primary outcome was pregnancy loss or high-level neonatal care for more than 48 hours during the first 28 postnatal days. The secondary outcome was serious maternal complications up to 6 weeks postpartum or until hospital discharge, whichever was later.
The rate of the primary outcome was similar in both groups (less-tight control, 31.4%; tight control, 30.7%; adjusted OR=1.02; 95% CI, 0.77-1.35). Most perinatal deaths were stillbirths and most high-level neonatal care for more than 48 hours was related to complications of prematurity.
The rate of serious maternal complications was similar between the groups (less-tight control, 3.7%; tight control, 2%; adjusted OR=1.74; 95% CI, 0.79-3.84). This was the case despite the less-tight-control group having a mean diastolic BP 4.6 mm Hg (95% CI, 3.7-5.4) and a mean systolic BP 5.8 mm Hg (95% CI, 4.5-7) higher than the tight-control group (P<.001 for both). There were no maternal deaths, and the most frequent maternal complication was receipt of blood products.
Severe maternal hypertension, defined as systolic BP ≥160 mm Hg/diastolic BP ≥110 mm Hg, which is a risk factor for acute stroke during and outside of pregnancy, developed in 40.6% of women in the less-tight-control group vs. 27.5% in the tight-control group (P<.001).
Disclosure: One researcher reports financial ties with Alere International.