Treating mild to moderate hypertension safe during pregnancy
Click Here to Manage Email Alerts
Key takeaways:
- A meta-analysis of 12 studies shows the benefits of treating mild to moderate hypertension during pregnancy.
- Data show hypertension treatment is safe during pregnancy, with no adverse outcomes for the fetus.
Pharmacological treatment of mild hypertension during pregnancy is associated with lower risks for several adverse outcomes, including severe hypertension, preeclampsia, placental abruption, renal impairment and pulmonary edema, data show.
“Hypertensive disorders of pregnancy have been associated with a significantly higher risk of adverse pregnancy outcomes including fetal and neonatal death and small for gestational age,” Alireza Hosseinpour, MD, of the department of cardiovascular medicine at Shiraz University of Medical Sciences, Iran, and colleagues wrote in Clinical Cardiology. “Although guidelines have reached a consensus on treating cases with severe hypertension (blood pressure 160/110 mm Hg), uncertainty still remains regarding the decision to treat patients with mild to moderate hypertension.”
Image: Adobe Stock
In a meta-analysis, Hosseinpour and colleagues analyzed data from 12 trials with 4,461 pregnant patients diagnosed with mild to moderate hypertension. All studies investigated the impact of pharmacological treatment in pregnant people with mild hypertension compared with no treatment or placebo on maternal, fetal and neonatal outcomes. There were 2,395 participants in the intervention group and 2,066 in the control group.
“Contrary to some of the previous meta‐analyses, we only included the results of the randomized controlled trials and, hence, our results represent the best evidence and are less likely to be influenced by confounding factors,” the researchers wrote. “We assessed the impact of treatment on participants with chronic and pregnancy‐induced hypertension and the analyses were stratified based on their type of hypertension. Thus, the results can be used for both types of hypertension during pregnancy.”
Researchers found that antihypertensive treatment was associated with better outcomes in seven of 19 analyzed outcomes, including severe hypertension (RR = 0.53; 95% CI, 0.38-0.75), preeclampsia (RR = 0.71; 95% CI, 0.54-0.93) and placental abruption (RR = 0.48; 95% CI, 0.26-0.87).
Data also showed antihypertensive treatment across the studies was beneficial for changes in ECG (RR = 0.43; 95% CI, 0.25-0.72), renal impairment (RR = 0.42; 95% CI, 0.34-0.51), pulmonary edema (RR = 0.46; 95% CI, 0.25-0.84) and neonatal mortality (RR = 0.72; 95% CI, 0.57-0.92).
The primary safety outcome of small for gestational age did not differ between intervention and control groups, according to the researchers.
“The adoption of lowering the favorite target of starting antihypertensive medications during pregnancy to the level of 140/90 mm Hg in patients affected by chronic and gestational hypertension in pregnancy seems acceptable,” the researchers wrote.
As Healio previously reported, data from the CHAP trial, presented at the 2022 American College of Cardiology Scientific Session, showed treating mild chronic hypertension during pregnancy to a BP goal of less than 140/90 mm Hg reduced adverse pregnancy outcomes and did not impair fetal growth. Pregnant women with mild chronic hypertension who received antihypertensive medication had significantly reduced rates of severe preeclampsia, preterm birth before 35 weeks gestation, placental abruption and fetal or neonatal death compared with a strategy of reserving treatment only for women who developed severe hypertension during pregnancy.
Collapse
Read more about
Click Here to Manage Email Alerts