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The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure?
Hypertension. 2016 11; 68(5):1153-1159.H

Abstract

To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of "less tight" (target diastolic blood pressure [dBP] 100 mm Hg) versus "tight" control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for >48 hours) and secondary outcomes (serious maternal complications), birth weight <10th percentile, preeclampsia, delivery at <34 or <37 weeks, platelets <100×109/L, elevated liver enzymes with symptoms, maternal length of stay ≥10 days, and maternal readmission before 6 weeks postpartum. Three hundred and thirty-four (34.1%) women in CHIPS developed severe hypertension that was associated with all outcomes examined except for maternal readmission (P=0.20): CHIPS primary outcome, birth weight <10th percentile, preeclampsia, preterm delivery, elevated liver enzymes (all P<0.001), platelets <100×109/L (P=0.006), and prolonged hospital stay (P=0.03). The association between severe hypertension and serious maternal complications was seen only in less tight control (P=0.02). Adjustment for preeclampsia (464, 47.3%) did not negate the relationship between severe hypertension and the CHIPS primary outcome (P<0.001), birth weight <10th percentile (P=0.005), delivery at <37 (P<0.001) or <34 weeks (P<0.001), or elevated liver enzymes with symptoms (P=0.02). Severe hypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preeclampsia co-occurrence.

CLINICAL TRIAL REGISTRATION

URL: http://pre-empt.cfri.ca/. Unique identifier: ISRCTN 71416914. URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01192412.

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Authors+Show Affiliations

Magee LA
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.). LMagee@sgul.ac.uk.
von Dadelszen P
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Singer J
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Lee T
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Rey E
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Ross S
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Asztalos E
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Murphy KE
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Menzies J
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Sanchez J
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Gafni A
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Helewa M
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Hutton E
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Koren G
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Lee SK
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Logan AG
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Ganzevoort W
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Welch R
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Thornton JG
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
Moutquin JM
From the Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's NHS Hospitals Foundation Trust, United Kingdom (L.A.M., P.v.D.); Department of Obstetrics and Gynaecology (L.A.M., P.v.D., J.M.) and School of Population and Public Health (J. Singer), University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada (T.L.); Medicine and Obstetrics and Gynaecology, University of Montreal, Canada (E.R.); Obstetrics and Gynaecology, University of Alberta, Canada (S.R.); Pediatrics (E.A., S.K.L., G.K.), Obstetrics and Gynaecology (E.A., K.E.M.), The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute (E.A., K.E.M., J. Sanchez), and Medicine (A.G.L.), University of Toronto, Canada; Clinical Epidemiology and Biostatistics (A.G.) and Obstetrics and Gynaecology (E.H.), McMaster University, Canada; Obstetrics and Gynaecology, University of Manitoba, Canada (M.H.); Obstetrics and Gynaecology, University of Amsterdam, Netherlands (W.G.); Obstetrics and Gynaecology, Derriford Hospital, United Kingdom (R.W.); Obstetrics and Gynaecology, University of Nottingham, United Kingdom (J.G.T.); and Obstetrics and Gynaecology, Universite de Sherbrooke, Canada (J.-M.M.).
CHIPS Study Group*
No affiliation info available

MeSH

AdultAntihypertensive AgentsBirth WeightFemaleHumansHypertension, Pregnancy-InducedInfant, NewbornLabetalolLogistic ModelsMaternal HealthMethyldopaMultivariate AnalysisPre-EclampsiaPregnancyPregnancy Complications, CardiovascularPregnancy OutcomePremature BirthProspective StudiesRisk AssessmentSeverity of Illness IndexStrokeTreatment Outcome

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27620393

Clinical Trial Links

Clinical trial which this article describes

Citation

Magee, Laura A., et al. "The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure?" Hypertension (Dallas, Tex. : 1979), vol. 68, no. 5, 2016, pp. 1153-1159.
Magee LA, von Dadelszen P, Singer J, et al. The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure? Hypertension. 2016;68(5):1153-1159.
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., Helewa, M., Hutton, E., Koren, G., Lee, S. K., Logan, A. G., Ganzevoort, W., Welch, R., Thornton, J. G., & Moutquin, J. M. (2016). The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure? Hypertension (Dallas, Tex. : 1979), 68(5), 1153-1159.
Magee LA, et al. The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure. Hypertension. 2016;68(5):1153-1159. PubMed PMID: 27620393.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure? AU - Magee,Laura A, AU - von Dadelszen,Peter, AU - Singer,Joel, AU - Lee,Terry, AU - Rey,Evelyne, AU - Ross,Susan, AU - Asztalos,Elizabeth, AU - Murphy,Kellie E, AU - Menzies,Jennifer, AU - Sanchez,Johanna, AU - Gafni,Amiram, AU - Helewa,Michael, AU - Hutton,Eileen, AU - Koren,Gideon, AU - Lee,Shoo K, AU - Logan,Alexander G, AU - Ganzevoort,Wessel, AU - Welch,Ross, AU - Thornton,Jim G, AU - Moutquin,Jean-Marie, AU - ,, Y1 - 2016/09/12/ PY - 2016/05/17/received PY - 2016/08/12/accepted PY - 2016/9/14/pubmed PY - 2017/8/8/medline PY - 2016/9/14/entrez KW - antihypertensive therapy KW - hypertension KW - labetalol KW - methyldopa KW - pregnancy SP - 1153 EP - 1159 JF - Hypertension (Dallas, Tex. : 1979) JO - Hypertension VL - 68 IS - 5 N2 - : To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of "less tight" (target diastolic blood pressure [dBP] 100 mm Hg) versus "tight" control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for >48 hours) and secondary outcomes (serious maternal complications), birth weight <10th percentile, preeclampsia, delivery at <34 or <37 weeks, platelets <100×109/L, elevated liver enzymes with symptoms, maternal length of stay ≥10 days, and maternal readmission before 6 weeks postpartum. Three hundred and thirty-four (34.1%) women in CHIPS developed severe hypertension that was associated with all outcomes examined except for maternal readmission (P=0.20): CHIPS primary outcome, birth weight <10th percentile, preeclampsia, preterm delivery, elevated liver enzymes (all P<0.001), platelets <100×109/L (P=0.006), and prolonged hospital stay (P=0.03). The association between severe hypertension and serious maternal complications was seen only in less tight control (P=0.02). Adjustment for preeclampsia (464, 47.3%) did not negate the relationship between severe hypertension and the CHIPS primary outcome (P<0.001), birth weight <10th percentile (P=0.005), delivery at <37 (P<0.001) or <34 weeks (P<0.001), or elevated liver enzymes with symptoms (P=0.02). Severe hypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preeclampsia co-occurrence. CLINICAL TRIAL REGISTRATION: URL: http://pre-empt.cfri.ca/. Unique identifier: ISRCTN 71416914. URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01192412. SN - 1524-4563 UR - https://www.unboundmedicine.com/medline/citation/27620393/The_CHIPS_Randomized_Controlled_Trial__Control_of_Hypertension_in_Pregnancy_Study_:_Is_Severe_Hypertension_Just_an_Elevated_Blood_Pressure DB - PRIME DP - Unbound Medicine ER -