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Influence of Gestational Age at Initiation of Antihypertensive Therapy: Secondary Analysis of CHIPS Trial Data (Control of Hypertension in Pregnancy Study).
Hypertension. 2018 06; 71(6):1170-1177.H

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.

CLINICAL TRIAL REGISTRATION

URL: https://www.isrctn.com. Unique identifier: ISRCTN71416914.

Links

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Authors+Show Affiliations

Pels A
From the Department of Obstetrics and Gynecology, Academisch Medisch Centrum, Amsterdam, The Netherlands (A.P., W.G.).
Mol BWJ
Department of Medicine, Robinson Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Australia (B.W.J.M.). South Australian Health and Medical Research Institute, Adelaide, Australia (B.W.J.M.).
Singer J
School of Public and Population Health (J.S., T.L.). Department of Obstetrics and Gynecology (J.S., T.L.), University of British Columbia, Vancouver, Canada.
Lee T
School of Public and Population Health (J.S., T.L.). Department of Obstetrics and Gynecology (J.S., T.L.), University of British Columbia, Vancouver, Canada.
von Dadelszen P
School of Life Course Sciences, King's College London, United Kingdom (P.v.D., L.A.M.).
Ganzevoort W
From the Department of Obstetrics and Gynecology, Academisch Medisch Centrum, Amsterdam, The Netherlands (A.P., W.G.).
Asztalos E
Department of Pediatrics, Obstetrics, and Gynecology, University of Toronto, Canada (E.A.). Department of Pediatrics, Sunnybrook Health Sciences, Toronto, Canada (E.A.).
Magee LA
School of Life Course Sciences, King's College London, United Kingdom (P.v.D., L.A.M.) laura.a.magee@kcl.ac.uk.
CHIPS Study Group
No affiliation info available

MeSH

AdultAntihypertensive AgentsBirth WeightBlood PressureFemaleGestational AgeHumansHypertension, Pregnancy-InducedInfant, NewbornMalePregnancyPregnancy Complications, CardiovascularPregnancy Outcome

Pub Type(s)

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

Language

eng

PubMed ID

29686009

Citation

Pels, Anouk, et al. "Influence of Gestational Age at Initiation of Antihypertensive Therapy: Secondary Analysis of CHIPS Trial Data (Control of Hypertension in Pregnancy Study)." Hypertension (Dallas, Tex. : 1979), vol. 71, no. 6, 2018, pp. 1170-1177.
Pels A, Mol BWJ, Singer J, et al. Influence of Gestational Age at Initiation of Antihypertensive Therapy: Secondary Analysis of CHIPS Trial Data (Control of Hypertension in Pregnancy Study). Hypertension. 2018;71(6):1170-1177.
Pels, A., Mol, B. W. J., Singer, J., Lee, T., von Dadelszen, P., Ganzevoort, W., Asztalos, E., & Magee, L. A. (2018). Influence of Gestational Age at Initiation of Antihypertensive Therapy: Secondary Analysis of CHIPS Trial Data (Control of Hypertension in Pregnancy Study). Hypertension (Dallas, Tex. : 1979), 71(6), 1170-1177. https://doi.org/10.1161/HYPERTENSIONAHA.117.10689
Pels A, et al. Influence of Gestational Age at Initiation of Antihypertensive Therapy: Secondary Analysis of CHIPS Trial Data (Control of Hypertension in Pregnancy Study). Hypertension. 2018;71(6):1170-1177. PubMed PMID: 29686009.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of Gestational Age at Initiation of Antihypertensive Therapy: Secondary Analysis of CHIPS Trial Data (Control of Hypertension in Pregnancy Study). AU - Pels,Anouk, AU - Mol,Ben Willem J, AU - Singer,Joel, AU - Lee,Terry, AU - von Dadelszen,Peter, AU - Ganzevoort,Wessel, AU - Asztalos,Elizabeth, AU - Magee,Laura A, AU - ,, Y1 - 2018/04/23/ PY - 2017/12/07/received PY - 2017/12/27/revised PY - 2018/03/13/accepted PY - 2018/4/25/pubmed PY - 2019/3/1/medline PY - 2018/4/25/entrez KW - blood pressure KW - fetal growth restriction KW - humans KW - hypertension, pregnancy-induced KW - preeclampsia KW - pregnancy outcome SP - 1170 EP - 1177 JF - Hypertension (Dallas, Tex. : 1979) JO - Hypertension VL - 71 IS - 6 N2 - : 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. CLINICAL TRIAL REGISTRATION: URL: https://www.isrctn.com. Unique identifier: ISRCTN71416914. SN - 1524-4563 UR - https://www.unboundmedicine.com/medline/citation/29686009/Influence_of_Gestational_Age_at_Initiation_of_Antihypertensive_Therapy:_Secondary_Analysis_of_CHIPS_Trial_Data__Control_of_Hypertension_in_Pregnancy_Study__ DB - PRIME DP - Unbound Medicine ER -