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Control of Hypertension In Pregnancy Study randomised controlled trial-are the results dependent on the choice of labetalol or methyldopa?
BJOG. 2016 Jun; 123(7):1135-41.BJOG

Abstract

OBJECTIVE

To determine whether the difference in outcomes between 'less tight' (target diastolic blood pressure [dBP] of 100 mmHg) versus 'tight' control (target dBP of 85 mmHg) in the CHIPS Trial (ISRCTN 71416914, http://pre-empt.cfri.ca/;CHIPS) depended on the choice of labetalol or methyldopa, the two most commonly used antihypertensive agents in CHIPS.

DESIGN

Secondary analysis of CHIPS Trial data.

SETTING

International multicentre randomised controlled trial (94 sites, 15 countries).

POPULATION OR SAMPLE

A total of 987 women with non-severe non-proteinuric pregnancy hypertension.

METHODS

Logistic regression was used for comparisons of 'less tight' versus 'tight' control among women treated with labetalol (but not methydopa) versus methyldopa (but not labetalol). Analyses were adjusted for the influence of baseline factors, including use of any antihypertensive therapy at randomisation.

MAIN OUTCOME MEASURES

Main CHIPS Trial outcomes: primary (perinatal loss or high-level neonatal care for > 48 hours), secondary (serious maternal complications), birthweight < 10th centile, severe maternal hypertension, pre-eclampsia, and delivery at < 34 or < 37 weeks.

RESULTS

Of 987 women in CHIPS, antihypertensive therapy was taken by 566 women at randomisation (labetalol 111 ['less tight'] versus 127 ['tight'] or methyldopa 126 ['less tight'] versus 117 ['tight']) and 815 women after randomisation (labetalol 186 ['less tight'] versus 247 ['tight'] and methyldopa by 98 ['less tight'] versus 126 ['tight']). Following adjustment, odds ratios for outcomes in 'less tight' versus 'tight' control were similar between antihypertensive groups according to 'at randomisation' and 'after randomisation' therapy.

CONCLUSION

Outcomes for 'less tight' versus 'tight' control were not dependent on use of methyldopa or labetalol.

TWEETABLE ABSTRACT

In the CHIPS Trial, maternal and infant outcomes were not dependent on use of labetalol or methyldopa.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Magee LA
Medicine, University of British Columbia, Vancouver, BC, Canada. Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
CHIPS Study Group
No affiliation info available
von Dadelszen P
Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
Singer J
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, BC, Canada.
Lee T
Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, BC, Canada.
Rey E
Medicine and Obstetrics and Gynaecology, University of Montreal, Montreal, QC, Canada.
Ross S
Obstetrics and Gynaecology, University of Alberta, Edmonton, AB, Canada.
Asztalos E
Paediatrics, University of Toronto, Toronto, ON, Canada. Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada. The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
Murphy KE
Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada. The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
Menzies J
Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.
Sanchez J
The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
Gafni A
Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
Gruslin A
Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON, Canada.
Helewa M
Obstetrics and Gynaecology, University of Manitoba, Winnipeg, MB, Canada.
Hutton E
Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada.
Koren G
Paediatrics, University of Toronto, Toronto, ON, Canada.
Lee SK
Paediatrics, University of Toronto, Toronto, ON, Canada.
Logan AG
Medicine, University of Toronto, Toronto, ON, Canada.
Ganzevoort JW
Obstetrics and Gynaecology, University of Amsterdam, Amsterdam, the Netherlands.
Welch R
Obstetrics and Gynaecology, Derriford Hospital, Plymouth, UK.
Thornton JG
Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK.
Moutquin JM
Obstetrics and Gynaecology, Universite de Sherbrooke, Sherbrooke, QC, Canada.

MeSH

AdultAntihypertensive AgentsBlood PressureClinical Decision-MakingFemaleHumansHypertensionHypertension, Pregnancy-InducedInfant, Low Birth WeightLabetalolMethyldopaPre-EclampsiaPregnancyPregnancy Complications, CardiovascularPremature BirthPrenatal CareRisk FactorsTreatment Outcome

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

26259808

Citation

Magee, L A., et al. "Control of Hypertension in Pregnancy Study Randomised Controlled Trial-are the Results Dependent On the Choice of Labetalol or Methyldopa?" BJOG : an International Journal of Obstetrics and Gynaecology, vol. 123, no. 7, 2016, pp. 1135-41.
Magee LA, CHIPS Study Group, von Dadelszen P, et al. Control of Hypertension In Pregnancy Study randomised controlled trial-are the results dependent on the choice of labetalol or methyldopa? BJOG. 2016;123(7):1135-41.
Magee, L. A., von Dadelszen, P., Singer, J., Lee, T., Rey, E., Ross, S., Asztalos, E., Murphy, K. E., Menzies, J., Sanchez, J., Gafni, A., Gruslin, A., Helewa, M., Hutton, E., Koren, G., Lee, S. K., Logan, A. G., Ganzevoort, J. W., Welch, R., ... Moutquin, J. M. (2016). Control of Hypertension In Pregnancy Study randomised controlled trial-are the results dependent on the choice of labetalol or methyldopa? BJOG : an International Journal of Obstetrics and Gynaecology, 123(7), 1135-41. https://doi.org/10.1111/1471-0528.13568
Magee LA, et al. Control of Hypertension in Pregnancy Study Randomised Controlled Trial-are the Results Dependent On the Choice of Labetalol or Methyldopa. BJOG. 2016;123(7):1135-41. PubMed PMID: 26259808.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Control of Hypertension In Pregnancy Study randomised controlled trial-are the results dependent on the choice of labetalol or methyldopa? AU - Magee,L A, AU - ,, AU - von Dadelszen,P, AU - Singer,J, AU - Lee,T, AU - Rey,E, AU - Ross,S, AU - Asztalos,E, AU - Murphy,K E, AU - Menzies,J, AU - Sanchez,J, AU - Gafni,A, AU - Gruslin,A, AU - Helewa,M, AU - Hutton,E, AU - Koren,G, AU - Lee,S K, AU - Logan,A G, AU - Ganzevoort,J W, AU - Welch,R, AU - Thornton,J G, AU - Moutquin,J-M, Y1 - 2015/08/11/ PY - 2015/06/04/accepted PY - 2015/8/12/entrez PY - 2015/8/12/pubmed PY - 2018/7/31/medline KW - Antihypertensive therapy KW - hypertension KW - labetalol KW - methyldopa KW - pregnancy SP - 1135 EP - 41 JF - BJOG : an international journal of obstetrics and gynaecology JO - BJOG VL - 123 IS - 7 N2 - OBJECTIVE: To determine whether the difference in outcomes between 'less tight' (target diastolic blood pressure [dBP] of 100 mmHg) versus 'tight' control (target dBP of 85 mmHg) in the CHIPS Trial (ISRCTN 71416914, http://pre-empt.cfri.ca/;CHIPS) depended on the choice of labetalol or methyldopa, the two most commonly used antihypertensive agents in CHIPS. DESIGN: Secondary analysis of CHIPS Trial data. SETTING: International multicentre randomised controlled trial (94 sites, 15 countries). POPULATION OR SAMPLE: A total of 987 women with non-severe non-proteinuric pregnancy hypertension. METHODS: Logistic regression was used for comparisons of 'less tight' versus 'tight' control among women treated with labetalol (but not methydopa) versus methyldopa (but not labetalol). Analyses were adjusted for the influence of baseline factors, including use of any antihypertensive therapy at randomisation. MAIN OUTCOME MEASURES: Main CHIPS Trial outcomes: primary (perinatal loss or high-level neonatal care for > 48 hours), secondary (serious maternal complications), birthweight < 10th centile, severe maternal hypertension, pre-eclampsia, and delivery at < 34 or < 37 weeks. RESULTS: Of 987 women in CHIPS, antihypertensive therapy was taken by 566 women at randomisation (labetalol 111 ['less tight'] versus 127 ['tight'] or methyldopa 126 ['less tight'] versus 117 ['tight']) and 815 women after randomisation (labetalol 186 ['less tight'] versus 247 ['tight'] and methyldopa by 98 ['less tight'] versus 126 ['tight']). Following adjustment, odds ratios for outcomes in 'less tight' versus 'tight' control were similar between antihypertensive groups according to 'at randomisation' and 'after randomisation' therapy. CONCLUSION: Outcomes for 'less tight' versus 'tight' control were not dependent on use of methyldopa or labetalol. TWEETABLE ABSTRACT: In the CHIPS Trial, maternal and infant outcomes were not dependent on use of labetalol or methyldopa. SN - 1471-0528 UR - https://www.unboundmedicine.com/medline/citation/26259808/Control_of_Hypertension_In_Pregnancy_Study_randomised_controlled_trial_are_the_results_dependent_on_the_choice_of_labetalol_or_methyldopa DB - PRIME DP - Unbound Medicine ER -