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The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure?

Magee, LA; von Dadelszen, P; Singer, J; Lee, T; Rey, E; Ross, S; Asztalos, E; Murphy, KE; Menzies, J; Sanchez, J; et al. Magee, LA; von Dadelszen, P; Singer, J; Lee, T; Rey, E; Ross, S; Asztalos, E; Murphy, KE; Menzies, J; Sanchez, J; Gafni, A; Helewa, M; Hutton, E; Koren, G; Lee, SK; Logan, AG; Ganzevoort, W; Welch, R; Thornton, JG; Moutquin, J-M; CHIPS Study Group (2016) The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure? Hypertension, 68 (5). pp. 1153-1159. ISSN 1524-4563 https://doi.org/10.1161/HYPERTENSIONAHA.116.07862
SGUL Authors: Magee, Laura Ann

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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 <100×10(9)/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 <100×10(9)/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.

Item Type: Article
Additional Information: © 2016 The Authors. Hypertension is published on behalf of the American Heart Association, Inc., by Wolters Kluwer. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDervis License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.
Keywords: antihypertensive therapy, hypertension, labetalol, methyldopa, pregnancy, CHIPS Study Group, antihypertensive therapy, hypertension, labetalol, methyldopa, pregnancy, Cardiovascular System & Hematology, 1103 Clinical Sciences, 1102 Cardiovascular Medicine And Haematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Hypertension
ISSN: 1524-4563
Language: ENG
Dates:
DateEvent
November 2016Published
12 September 2016Published Online
12 August 2016Accepted
Publisher License: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
Projects:
Project IDFunderFunder ID
MCT 87522Canadian Institutes of Health Researchhttp://dx.doi.org/10.13039/501100000024
PubMed ID: 27620393
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/108268
Publisher's version: https://doi.org/10.1161/HYPERTENSIONAHA.116.07862

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