Key result
Women with ACC-AHA defined hypertension developed preeclampsia at a rate of 45.1%, which was not significantly different from the 60.0% rate among women with ACOG defined hypertension (p=0.288).
Why the study?
To compare the rate of adverse pregnancy outcomes among women with hypertension defined by ACC-AHA guidelines, ACOG guidelines, and normotensive women.
Does hypertension defined by ACC-AHA guidelines increase the risk of adverse pregnancy outcomes compared to ACOG guidelines or normotension in pregnant women?
Cohort (n=252)
Does hypertension defined by ACC-AHA guidelines increase the risk of adverse pregnancy outcomes compared to ACOG guidelines or normotension in pregnant women?
Absolute Event Rate: 45.1% vs 60%
p-value: p=0.288
Women meeting the lower ACC-AHA thresholds for hypertension have a similar risk of developing preeclampsia as those meeting the higher ACOG thresholds, both of which are significantly higher than normotensive women.
Women meeting ACC-AHA hypertension criteria face preeclampsia risk similar to ACOG-defined cases; leaves open whether lower thresholds should guide earlier intervention.
Objective To compare the rate of adverse pregnancy outcomes of women with hypertension defined by the ACC-AHA guidelines, women with hypertension defined by ACOG guidelines, and normotensive women.Methods A historical cohort study of women with singleton, nonanomalous pregnancies who presented before 20 weeks for their first prenatal visit between 1 January 2014 and 31 January 2016 with (a) hypertension defined by ACC-AHA (systolic blood pressure 130 mmHg and/or diastolic blood pressure of 80 mmHg documented), (b) hypertension defined by ACOG (systolic blood pressure of 140 mmHg and/or diastolic blood pressure of 90 mmHg documented) and (c) women documented to be normotensive. Primary outcomes were preeclampsia and small for gestational age. Fisher’s exact test was used to compare demographics and risk factors between the groups. Multivariable logistic regression analysis was used to predict the association of preeclampsia within the groups adjusting for additional risk factors.Results A total of 252 women were included. Of these, 92 (36.5%) had hypertension by ACC-AHA, 34 (13.5%) by ACOG and 126 (50%) were normotensive. Sixty percent of women with the ACOG definition developed preeclampsia compared to 45.1% of women with the ACC-AHA definition and 17.1% in the control group (p < .001). The rate of preeclampsia among women with hypertension by ACC-AHA criteria was not significantly different from the rate among women with hypertension by ACOG criteria (p = .288). Differences in small for gestational age among the groups were not significant (ACOG: 20%, ACC-AHA: 11.1%, normotensive: 9.8%, p = .423).Conclusion Women with hypertension defined by ACC-AHA have a rate of developing preeclampsia that is similar to that of women with hypertension defined by ACOG.
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McLaren et al. (2019) conducted a cohort in Hypertension in pregnancy (n=252). Hypertension defined by ACC-AHA guidelines vs. Hypertension defined by ACOG guidelines was evaluated on Preeclampsia and small for gestational age (p=0.288). Women with ACC-AHA defined hypertension developed preeclampsia at a rate of 45.1%, which was not significantly different from the 60.0% rate among women with ACOG defined hypertension (p=0.288).
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