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Less-tight versus tight control of hypertension in pregnancy.

Magee, LA; von Dadelszen, P; Rey, E; Ross, S; Asztalos, E; Murphy, KE; Menzies, J; Sanchez, J; Singer, J; Gafni, A; et al. Magee, LA; von Dadelszen, P; Rey, E; Ross, S; Asztalos, E; Murphy, KE; Menzies, J; Sanchez, J; Singer, J; Gafni, A; Gruslin, A; Helewa, M; Hutton, E; Lee, SK; Lee, T; Logan, AG; Ganzevoort, W; Welch, R; Thornton, JG; Moutquin, JM (2015) Less-tight versus tight control of hypertension in pregnancy. The New England Journal of Medicine, 372 (5). pp. 407-417. ISSN 0028-4793
SGUL Authors: von Dadelszen, Peter

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BACKGROUND: The effects of less-tight versus tight control of hypertension on pregnancy complications are unclear. METHODS: We performed an open, international, multicenter trial involving women at 14 weeks 0 days to 33 weeks 6 days of gestation who had nonproteinuric preexisting or gestational hypertension, office diastolic blood pressure of 90 to 105 mm Hg (or 85 to 105 mm Hg if the woman was taking antihypertensive medications), and a live fetus. Women were randomly assigned to less-tight control (target diastolic blood pressure, 100 mm Hg) or tight control (target diastolic blood pressure, 85 mm Hg). The composite primary outcome was pregnancy loss or high-level neonatal care for more than 48 hours during the first 28 postnatal days. The secondary outcome was serious maternal complications occurring up to 6 weeks post partum or until hospital discharge, whichever was later. RESULTS: Included in the analysis were 987 women; 74.6% had preexisting hypertension. The primary-outcome rates were similar among 493 women assigned to less-tight control and 488 women assigned to tight control (31.4% and 30.7%, respectively; adjusted odds ratio, 1.02; 95% confidence interval [CI], 0.77 to 1.35), as were the rates of serious maternal complications (3.7% and 2.0%, respectively; adjusted odds ratio, 1.74; 95% CI, 0.79 to 3.84), despite a mean diastolic blood pressure that was higher in the less-tight-control group by 4.6 mm Hg (95% CI, 3.7 to 5.4). Severe hypertension (≥160/110 mm Hg) developed in 40.6% of the women in the less-tight-control group and 27.5% of the women in the tight-control group (P<0.001). CONCLUSIONS: We found no significant between-group differences in the risk of pregnancy loss, high-level neonatal care, or overall maternal complications, although less-tight control was associated with a significantly higher frequency of severe maternal hypertension. (Funded by the Canadian Institutes of Health Research; CHIPS Current Controlled Trials number, ISRCTN71416914; number, NCT01192412.).

Item Type: Article
Additional Information: From New England Journal of Medicine, Laura A. Magee, M.D., Peter von Dadelszen, M.B., Ch.B., D.Phil., Evelyne Rey, M.D., Susan Ross, M.B.A., Ph.D., Elizabeth Asztalos, M.D., Kellie E. Murphy, M.D., Jennifer Menzies, M.Sc., Johanna Sanchez, M.I.P.H., Joel Singer, Ph.D., Amiram Gafni, D.Sc., Andrée Gruslin, M.D.,* Michael Helewa, M.D., Eileen Hutton, Ph.D., Shoo K. Lee, M.D., Ph.D., Terry Lee, Ph.D., Alexander G. Logan, M.D., Wessel Ganzevoort, M.D., Ph.D., Ross Welch, M.B., B.S., D.A., M.D., Jim G. Thornton, M.B., Ch.B., M.D., and Jean‑Marie Moutquin, M.D., Less-Tight versus Tight Control of Hypertension in Pregnancy, Volume 372, No.5, Page 407 - 417. Copyright © 2015 Massachusetts Medical Society. Reprinted with permission.
Keywords: Abortion, Spontaneous, Adult, Antihypertensive Agents, Blood Pressure, Female, Humans, Hypertension, Pregnancy-Induced, Infant, Newborn, Intensive Care, Neonatal, Perinatal Death, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Puerperal Disorders, Humans, Pregnancy Complications, Abortion, Spontaneous, Hypertension, Pregnancy-Induced, Puerperal Disorders, Antihypertensive Agents, Pregnancy Outcome, Intensive Care, Neonatal, Pregnancy, Blood Pressure, Adult, Infant, Newborn, Female, Perinatal Death, General & Internal Medicine, 11 Medical And Health Sciences
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: The New England Journal of Medicine
ISSN: 0028-4793
Language: eng
29 January 2015Published
Publisher License: Publisher's own licence
Project IDFunderFunder ID
MCT 87522Canadian Institutes of Health Research
PubMed ID: 25629739
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