Setting lower BP targets safe and effective for improving pregnancy outcomes, CHAP trial: ACC 2022
It is well known that hypertension in pregnancy worsens outcomes for both mothers and their offspring and clear guideline recommendations for the treatment of hypertension in pregnancy for women with severe hypertension. What remains unknown is whether the pregnant patients with milder degrees of hypertension (SBP-140-160mmHg) should be treated with antihypertensives or not?
In the latest issue of NEJM, Tita et al have shown that managing mild gestational hypertension improves the primary outcomes like preeclampsia with severe features, preterm birth, placental abruption, or perinatal death without compromising the safety of fetus. The trial was subsequently presented at ACC 2022.
The CHAP trial conducted at 61 sites compared the treatment of otherwise uncomplicated hypertension at two different blood-pressure thresholds. Enrolled in the trial were pregnant women who had mild hypertension, which was defined as a systolic blood pressure between 140 and 160 mm Hg and a diastolic blood pressure between 90 and 105 mm Hg.
All the women had a singleton fetus of less than 23 weeks of gestation. The women were randomly assigned in a 1:1 ratio to receive either active treatment with an antihypertensive agent that targeted a blood pressure of less than 140/90 mm Hg or to receive standard (control) treatment, with initiation of treatment to the same target only if there was an increase in the systolic pressure beyond 160 mm Hg or in the diastolic pressure beyond 105 mm Hg (severe hypertension).
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