WASHINGTON — Consensus is increasing that clinicians will even be assured treating soft hypertension in otherwise healthy pregnant women without hurting their babies, in accordance to the CHAP test.
On this neat randomized trial, treating high blood stress (BP) to a target of <140/90 mm Hg resulted in better outcomes than did usual care, as evidenced by the reduced combined incidence of pre-eclampsia with severe features, medically indicated preterm birth at less than 35 weeks' gestation, placental abruption, and fetal or neonatal death (30.2% vs 37.0%, adjusted RR 0.82, 95% CI 0.74-0.92), reported Alan Tita, MD, PhD, of the University of Alabama at Birmingham.
Notably, hypertension treatment did not appear to harm babies or mothers. The study’s treatment and control groups did not differ in the safety outcomes of small-for-gestational-age births below the 10th percentile, serious maternal complications, or severe neonatal complications, he said in a presentation at the American College of Cardiology (ACC) meeting. The results were simultaneously published in the New England Journal of Medicine (NEJM).
CHAP persevered through difficult recruitment to enroll over 2,400 pregnant women.
This trial is “practice-changing,” as “one of the reasons we don’t have as much data in pregnant patients is some of the logistical and ethical concerns that we’ve had,” according to ACC immediate past president Athena Poppas, MD, of Warren Alpert Medical School of Brown University in Providence, Rhode Island, during the session’s panel discussion.
Indeed, Tita noted that major pregnancy and obstetrics societies are already aware of CHAP and working to incorporate the results in new recommendations. “In the next few weeks, we’ll see some momentum to move toward these new findings,” he said at an ACC press conference.
Chronic high BP has previously been tied to pre-eclampsia, preterm birth, maternal death, heart failure, and stroke in pregnant women.
For the CHAP study, Tita’s group enrolled 2,408 pregnant women with mild chronic hypertension and singleton fetuses at a gestational age of less than 23 weeks. Notably, this was a relatively diverse cohort, with nearly half of people being Black.
Participants were randomized to receive antihypertensive medications or have treatment withheld until the development of severe hypertension (>160/105 mm Hg). The most effectively favored antihypertensives were labetalol and prolonged-free up nifedipine.
Between the groups, there modified into once a small difference in imply BP from randomization to present: 129.5/79.1 mm Hg with cure versus 132.6/81.5 mm Hg for controls.
Tita acknowledged that his personnel is never any longer certain whether one amongst the 2 test remedy modified into once larger for sufferers in accordance to the trial.
“Evaluation of the prolonged-term stop of antihypertensive cure on cardiovascular and other outcomes in pregnant women with soft continual hypertension and their offspring might well possibly extra elaborate the role of antihypertensive remedy,” the authors added.
“The nearly the same values for placental weight in the 2 cure groups [466.3 g vs 464.6 g, treatment effect 1.67, 95% CI -17.57 to 20.91] give extra assurance of the protection of the active cure. The absence of any evidence of diminished fetal inform with more aggressive cure is terribly reassuring and is in accordance to the findings of the CHIPS investigators,” mentioned NEJM editors Michael Greene, MD, and Winfred Williams, MD, each and each of Massachusetts Total Clinical institution in Boston.
They highlighted the obvious reduction of pre-eclampsia-linked outcomes after hypertension cure in an accompanying editorial.
“As secondary outcomes no longer adjusted for multiplicity, these findings desires to be regarded with warning. Alternatively, if the outcomes are confirmed in subsequent research, such outcomes would be a compelling reason to swap the solutions for scientific phrase referring to the cure of soft hypertension all by pregnancy,” Greene and Williams wrote.
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Nicole Lou is a reporter for MedPage This day, where she covers cardiology recordsdata and other developments in remedy. Observe
Disclosures
CHAP modified into once funded by the National Heart, Lung, and Blood Institute.
Tita, Greene, and Williams disclosed no relationships with industry.
