Key result
Higher achieved diastolic blood pressure (≥90 mmHg) during pregnancy was associated with increased fetal or neonatal mortality and morbidities compared to <90 mmHg.
Why the study?
The study was conducted to investigate the relationship between blood pressure achieved during pregnancy and pregnant outcomes in non-severe chronic hypertensive women.
Does achieving a lower diastolic blood pressure (<90 mmHg) improve fetal/neonatal and maternal outcomes in pregnant women with non-severe chronic hypertension?
Cohort (n=305)
No
Does achieving a lower diastolic blood pressure (<90 mmHg) improve fetal/neonatal and maternal outcomes in pregnant women with non-severe chronic hypertension?
Achieving a mean antenatal office diastolic blood pressure <90 mmHg in pregnant women with non-severe chronic hypertension is associated with significantly reduced risks of adverse fetal, neonatal, and maternal outcomes.
Answers are grounded in this paper and cite their sources.
Lower achieved BP associated with better outcomes in non-severe chronic hypertension; leaves open optimal targets pending randomized trials.
OBJECTIVES: To investigate the relationship between blood pressure (BP) achieved during pregnancy and pregnant outcomes in non-severe chronic hypertensive women. STUDY DESIGN: This retrospective cohort study included pregnant women who diagnosed as non-severe chronic hypertension and delivered in Shanghai Renji Hospital from January 2010 to March 2017. Based on their mean antenatal office diastolic BP (dBP), patients were divided into higher BP achieved (HBPA, dBP ≥ 90 mmHg) group or lower BP achieved (LBPA, dBP < 90 mmHg) group. Primary outcome measurement was the composite of fetal or neonatal mortality and morbidities. Secondary outcomes were the adverse maternal outcomes. RESULTS: Eligible 305 patients were included, among whom 98 were in HBPA group and 207 were in LBPA group. The HBPA group had significantly higher antenatal dBP [95.0 ± 4.8 vs 81.7 ± 5.6 mmHg, P < 0.001] than the LBPA group. After adjusting for six confounding factors (age, body-mass index (BMI), weeks of gestation at first antenatal visit, dBP measured at first antenatal visit, antihypertensive medication usage during pregnancy, complicating other medical condition), primary outcome [34.7% vs 15.9%, 2.30 (1.23-4.30)] was significantly higher in HBPA group. The incidences of SGA [21.4% vs 11.1%, 2.12 (1.03-4.38)], NICU admission [19.4% vs 6.3%, 3.54 (1.48-8.49)], preeclampsia with severe features [22.4% vs 10.6%, 2.23 (1.10-4.54)], severe hypertension [8.2% vs 0.5%, 15.68 (1.78-138.04)] were higher, and earlier gestational age at delivery [37.1 ± 2.6 vs 37.7 ± 2.1, P = 0.031], lower birthweight [2861.0 ± 780.0 vs 3059.0 ± 616.3, P = 0.029] in the HBPA group. CONCLUSION: Lower BP achieved during gestation in pregnant women with non-severe chronic hypertension (CH) might improve both fetal/neonatal and maternal outcomes.
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Zhang et al. (2021) conducted a cohort in Non-severe chronic hypertension in pregnancy (n=305). Higher blood pressure achieved (dBP ≥ 90 mmHg) vs. Lower blood pressure achieved (dBP < 90 mmHg) was evaluated on Composite of fetal or neonatal mortality and morbidities (2.30, 95% CI 1.23-4.30). Higher achieved diastolic blood pressure (≥90 mmHg) during pregnancy was associated with increased fetal or neonatal mortality and morbidities compared to <90 mmHg.
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