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Management of non-severe pregnancy hypertension - A summary of the CHIPS Trial (Control of Hypertension in Pregnancy Study) research publications.
Pregnancy Hypertens. 2019 Oct; 18:156-162.PH

Abstract

The international CHIPS Trial (Control of Hypertension In Pregnancy Study) enrolled 987 women with chronic (75%) or gestational (25%) hypertension. Pre-eclampsia developed in 48%; women remained on their allocated BP control and delivered an average of two weeks later. 'Less tight' control (target diastolic BP 100 mmHg) achieved BP that was 6/5mmHg higher (p < 0.001) than 'tight' control (target diastolic 85 mmHg, BP achieved 133/85 mmHg). 'Less tight' (vs. 'tight') control resulted in similar adverse perinatal outcomes (31.5% vs. 30.7%; p = 0.84) that balanced birthweight < 10th percentile (16.1% vs. 19.8%; p = 0.14) against preterm birth (35.6% vs. 31.5%; p = 0.18). 12-month follow-up revealed no compelling evidence for developmental programming of child growth. However, 'less tight' (vs. 'tight') control resulted in more severe maternal hypertension (40.6% vs. 27.5%; p < 0.001), and more women with platelets < 100 × 109/L (4.3% vs. 1.6%; p = 0.02) or symptomatic elevated liver enzymes (4.3% vs. 1.8%; p = 0.03), with no difference in serious maternal complications (3.7% vs. 2.0%; p = 0.17). Labetalol was the drug of choice. Methyldopa did not result in inferior outcomes. Post-hoc, severe hypertension, independent of pre-eclampsia, was associated with heightened increased risk of adverse outcomes, and in 'less tight' control, of serious maternal complications. At no gestational age at initiation of BP control was 'less tight' superior to 'tight'. Women in both groups were equally satisfied with care. 'Less tight' control tended to be more expensive by CAD$6000 (p =0.07) based on neonatal care costs. Collectively, CHIPS publications have provided evidence that women with non-severe pregnancy hypertension should receive 'tight' BP control achieved by a simple algorithm.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Magee LA
Department of Women and Children's Health, King's College London, UK. Electronic address: Laura.A.Magee@kcl.ac.uk.
Rey E
Departments of Medicine and Obstetrics and Gynaecology, Université de Montreal, Canada.
Asztalos E
Department of Pediatrics, University of Toronto, Toronto, Canada.
Hutton E
McMaster University, Hamilton, Canada.
Singer J
School of Population and Public Health, Centre for Health Evaluation and Outcome Science, Providence Health Care Research Institute, University of British Columbia, Vancouver, Canada.
Helewa M
University of Manitoba, Canada.
Lee T
Centre for Health Evaluation and Outcome Science, Providence Health Care Research Institute, University of British Columbia, Vancouver, Canada.
Logan AG
Department of Medicine, University of Toronto, Canada.
Ganzevoort W
Department of Obstetrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
Welch R
University Hospitals Plymouth NHS Trust, UK.
Thornton JG
Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, UK.
von Dadelszen P
Department of Women and Children's Health, King's College London, UK.

MeSH

AdultAntihypertensive AgentsCanadaFemaleHumansHypertension, Pregnancy-InducedLabetalolPregnancyRandomized Controlled Trials as TopicResearch DesignTreatment Outcome

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

31627057

Citation

Magee, Laura A., et al. "Management of Non-severe Pregnancy Hypertension - a Summary of the CHIPS Trial (Control of Hypertension in Pregnancy Study) Research Publications." Pregnancy Hypertension, vol. 18, 2019, pp. 156-162.
Magee LA, Rey E, Asztalos E, et al. Management of non-severe pregnancy hypertension - A summary of the CHIPS Trial (Control of Hypertension in Pregnancy Study) research publications. Pregnancy Hypertens. 2019;18:156-162.
Magee, L. A., Rey, E., Asztalos, E., Hutton, E., Singer, J., Helewa, M., Lee, T., Logan, A. G., Ganzevoort, W., Welch, R., Thornton, J. G., & von Dadelszen, P. (2019). Management of non-severe pregnancy hypertension - A summary of the CHIPS Trial (Control of Hypertension in Pregnancy Study) research publications. Pregnancy Hypertension, 18, 156-162. https://doi.org/10.1016/j.preghy.2019.08.166
Magee LA, et al. Management of Non-severe Pregnancy Hypertension - a Summary of the CHIPS Trial (Control of Hypertension in Pregnancy Study) Research Publications. Pregnancy Hypertens. 2019;18:156-162. PubMed PMID: 31627057.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of non-severe pregnancy hypertension - A summary of the CHIPS Trial (Control of Hypertension in Pregnancy Study) research publications. AU - Magee,Laura A, AU - Rey,Evelyne, AU - Asztalos,Elizabeth, AU - Hutton,Eileen, AU - Singer,Joel, AU - Helewa,Michael, AU - Lee,Terry, AU - Logan,Alexander G, AU - Ganzevoort,Wessel, AU - Welch,Ross, AU - Thornton,Jim G, AU - von Dadelszen,Peter, Y1 - 2019/10/15/ PY - 2019/06/07/received PY - 2019/08/12/revised PY - 2019/08/24/accepted PY - 2019/10/19/pubmed PY - 2020/5/15/medline PY - 2019/10/19/entrez KW - Hypertension KW - Less tight control KW - Maternal outcome KW - Perinatal outcome KW - Pregnancy KW - Tight control SP - 156 EP - 162 JF - Pregnancy hypertension JO - Pregnancy Hypertens VL - 18 N2 - The international CHIPS Trial (Control of Hypertension In Pregnancy Study) enrolled 987 women with chronic (75%) or gestational (25%) hypertension. Pre-eclampsia developed in 48%; women remained on their allocated BP control and delivered an average of two weeks later. 'Less tight' control (target diastolic BP 100 mmHg) achieved BP that was 6/5mmHg higher (p < 0.001) than 'tight' control (target diastolic 85 mmHg, BP achieved 133/85 mmHg). 'Less tight' (vs. 'tight') control resulted in similar adverse perinatal outcomes (31.5% vs. 30.7%; p = 0.84) that balanced birthweight < 10th percentile (16.1% vs. 19.8%; p = 0.14) against preterm birth (35.6% vs. 31.5%; p = 0.18). 12-month follow-up revealed no compelling evidence for developmental programming of child growth. However, 'less tight' (vs. 'tight') control resulted in more severe maternal hypertension (40.6% vs. 27.5%; p < 0.001), and more women with platelets < 100 × 109/L (4.3% vs. 1.6%; p = 0.02) or symptomatic elevated liver enzymes (4.3% vs. 1.8%; p = 0.03), with no difference in serious maternal complications (3.7% vs. 2.0%; p = 0.17). Labetalol was the drug of choice. Methyldopa did not result in inferior outcomes. Post-hoc, severe hypertension, independent of pre-eclampsia, was associated with heightened increased risk of adverse outcomes, and in 'less tight' control, of serious maternal complications. At no gestational age at initiation of BP control was 'less tight' superior to 'tight'. Women in both groups were equally satisfied with care. 'Less tight' control tended to be more expensive by CAD$6000 (p =0.07) based on neonatal care costs. Collectively, CHIPS publications have provided evidence that women with non-severe pregnancy hypertension should receive 'tight' BP control achieved by a simple algorithm. SN - 2210-7797 UR - https://www.unboundmedicine.com/medline/citation/31627057/Management_of_non_severe_pregnancy_hypertension___A_summary_of_the_CHIPS_Trial__Control_of_Hypertension_in_Pregnancy_Study__research_publications_ DB - PRIME DP - Unbound Medicine ER -