Less-Tight versus Tight Control of Hypertension in Pregnancy

• Published in: The New England journal of medicine Vol. 372; no. 5; pp. 407 - 417
• Main Authors: Magee, Laura A, von Dadelszen, Peter, Rey, Evelyne, Ross, Susan, Asztalos, Elizabeth, Murphy, Kellie E, Menzies, Jennifer, Sanchez, Johanna, Singer, Joel, Gafni, Amiram, Gruslin, Andrée, Helewa, Michael, Hutton, Eileen, Lee, Shoo K, Lee, Terry, Logan, Alexander G, Ganzevoort, Wessel, Welch, Ross, Thornton, Jim G, Moutquin, Jean-Marie
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 29.01.2015
• Subjects: Abortion, Spontaneous - etiology; Adult; Antihypertensive Agents - administration & dosage; Antihypertensives; Blood pressure; Blood Pressure - drug effects; Clinical trials; Drug therapy; Female; Fetuses; Gestation; Humans; Hypertension; Hypertension, Pregnancy-Induced - drug therapy; Infant, Newborn; Intensive Care, Neonatal - statistics & numerical data; Maternal & child health; Neonates; Perinatal Death - etiology; Preeclampsia; Pregnancy; Pregnancy complications; Pregnancy Complications - epidemiology; Pregnancy Complications - etiology; Pregnancy Outcome; Proteins; Puerperal Disorders - etiology; Ultrasonic imaging; Womens health
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1404595

In this trial comparing less-tight control of hypertension (target diastolic blood pressure, 100 mm Hg) with tight control (85 mm Hg) among pregnant women, rates of pregnancy loss, high-level neonatal care, and serious maternal complications were similar between groups. Almost 10% of pregnant women have hypertension; hypertension is preexisting in 1%, gestational hypertension without proteinuria develops in 5 to 6%, and preeclampsia develops in 2%. 1 Preexisting hypertension and gestational hypertension before 34 weeks are associated with an increased risk of perinatal and maternal complications. 2 – 4 Blood-pressure targets for women with nonsevere hypertension during pregnancy are much debated. Relevant randomized, controlled trials have been small and of moderate or poor quality; tight control (the use of antihypertensive therapy to normalize blood pressure) has been associated with maternal benefits (e.g., a decrease in the frequency of severe hypertension and possibly in . . .