Influence of gestational age at initiation of antihypertensive therapy

Secondary analysis of CHIPS trial data (control of hypertension in pregnancy study)

behalf of the CHIPS Study Group

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight <10th centile (Pinteraction=0.005), but more preterm birth (Pinteraction=0.043), and no effect on perinatal death or high-level neonatal care >48 hours (Pinteraction=0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks (Pinteraction=0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes.

Original languageEnglish (US)
Pages (from-to)1170-1177
Number of pages8
JournalHypertension
Volume71
Issue number6
DOIs
StatePublished - Jan 1 2018

Fingerprint

Antihypertensive Agents
Gestational Age
Hypertension
Pregnancy
Random Allocation
Pregnancy Induced Hypertension
Mothers
Blood Pressure
Therapeutics
Fetal Development
Birth Weight
Logistic Models

Keywords

  • Blood pressure
  • Fetal growth restriction
  • Humans
  • Hypertension, pregnancy-induced
  • Preeclampsia
  • Pregnancy outcome

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Influence of gestational age at initiation of antihypertensive therapy : Secondary analysis of CHIPS trial data (control of hypertension in pregnancy study). / behalf of the CHIPS Study Group.

In: Hypertension, Vol. 71, No. 6, 01.01.2018, p. 1170-1177.

Research output: Contribution to journalArticle

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abstract = "For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight <10th centile (Pinteraction=0.005), but more preterm birth (Pinteraction=0.043), and no effect on perinatal death or high-level neonatal care >48 hours (Pinteraction=0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks (Pinteraction=0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes.",
keywords = "Blood pressure, Fetal growth restriction, Humans, Hypertension, pregnancy-induced, Preeclampsia, Pregnancy outcome",
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KW - Fetal growth restriction

KW - Humans

KW - Hypertension, pregnancy-induced

KW - Preeclampsia

KW - Pregnancy outcome

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