AHA/ACC hypertension definition identifies more women at risk for preeclampsia than ACOG

Kristin Darwin

The American College of Obstetrics and Gynecology hypertension criteria failed to identify women who are at moderately elevated risk for preeclampsia and preterm birth, but the American Heart Association/American College of Cardiology criteria did, according to a study presented at the Society for Maternal-Fetal Medicine annual meeting.

ACOG defines hypertension as 140 mm Hg/90 mm Hg and the AHA/ACC defines it as 130 mm Hg/80 mm Hg, according to researchers.

Kristin Darwin, MD, second-year fellow at Johns Hopkins University and colleagues analyzed BPs from 2,976 women from a previously existing cohort who were in their first trimester.

They found that women meeting the AHA criteria were more likely to develop preeclampsia compared with women with normal BP (11.6% vs. 3.1%; P < .001). The risk was only numerically different when compared to women meeting ACOG criteria (11.6% vs. 17.2%, P < 0.06) In addition, the AHA group fell between the normal BP cohort and ACOG group in terms of likelihood of preterm or late preterm delivery.

Darwin said the findings should not prompt a re-consideration of established BP guidelines.

“We agree with ACOG’s current recommendation for classification and management of chronic hypertension in pregnancy. This study is not designed to inform how to change practice,” she said in an interview.

“However, it importantly draws attention to this group of women that ACOG criteria does not identify who are at moderately elevated risk for preeclampsia and preterm birth. There needs to be additional investigations of this blood pressure group in order to better understand this group’s risk profile,” Darwin continued.

She added that clinicians should frequently discuss BP with their patients.

“Regardless of blood pressure at time of presentation to prenatal care, primary care physicians and OB/GYNs have an opportunity to discuss healthy habits and promote lifestyle changes (routine exercise, healthy diet) that can reduce their patient’s risk of future cardiovascular disease,” she told Healio Primary Care Today. – by Janel Miller

Reference:

Darwin K, et al. “Expansion of diagnostic criteria for hypertension identifies group at intermediate risk of adverse outcomes.” Presented at: Society for Maternal-Fetal Medicine annual meeting; Feb. 11-16, 2019; Las Vegas.

Disclosures: Healio Primary Care Today was unable to determine the authors’ relevant financial disclosure.