Influence of Gestational Age at Initiation of Antihypertensive Therapy: Secondary Analysis of CHIPS Trial Data (Control of Hypertension in Pregnancy Study). Issue 6 (June 2018)

• Record Type: Journal Article
• Authors: Pels, Anouk; Mol, Ben Willem J.; Singer, Joel; Lee, Terry; von Dadelszen, Peter; Ganzevoort, Wessel; Asztalos, Elizabeth; Magee, Laura A.; Gafni, Amiram; Gruslin, Andrée; Helewa, Michael; Hutton, Eileen; Lee, Shoo; Logan, Alexander; Menzies, Jennifer; Moutquin, Jean-Marie; Murphy, Kellie; Rey, Evelyne; Ross, Sue; Sanchez, Johanna; Thornton, Jim G.; Welch, Ross; Hoac, Trinh; Kirton, Joanne; Trigiani, Katherine; Zahid, Ainy; Bracken, Michael B.; Crowley, Patricia; Duley, Lelia; Ehrenkranz, Richard; Thorpe, Kevin; Chan, Sunny; Shi, Michael; Yu, Shelley; de Lourdes Martin, Raquel; Bassi, Maria Florencia; Caruso, Mirta Clara; Lagunas, Valeria; Vera, Fernando; Mohedano de Duhalde, Maria; Roque, Alicia Beatriz; Roldan, Patricia; Duhalde, Esteban Marcos; Dip, Viviana; Aguirre, Jesus Daniel; Morales, Elba Mirta Alicia; Abreo, Griselda Itati; De Sagastizabal, Teresa; Gomez, Carolina; Rizzi, Nadia; Arias, Carlos; Bruno, Ricardo Antonio; Mahomed, Kassam; Drew, Alison; Green, Ann; Hoare, Jane; Hague, Bill; Coat, Suzette; Crowther, Caroline; Muller, Peter; Trenowden, Sophie; Walters, Barry; Parker, Claire; Graham, Dorothy; Pennell, Craig; Sung, Eileen; Makris, Angela; Lee, Gaksoo; Thornton, Charlene; Hennessy, Annemarie; Farrell, Louise; Sass, Nelson; Korkes, Henri; Ferreira, Dayana Couto; Moreira de Sa, Renato Augusto; Abreu, Monique Schmidt Marques; Bornia, Rita Guerios; da Silva, Nancy Ribeiro; Cardoso, Fernanda Freitas Oliveira; Marques, Caio Coelho; Hornos, Jorge; Davdt, Ricardo Leal; Paula, Letícia Germany; Zanella, Pedro Luis; Inglis, Gabrielle; Dillon, Ruth; Docherty, Ashley; Hutfield, Anna; Still, Keith; Lalji, Sayrin; Van Tent, Tamara; Hotz, Chris; Messmer, Tracy; Ray, Joel G.; Berger, Howard; De Souza, Leanne; Lausman, Andrea; Freire-Lizama, Tatiana; Besel, Kate; Gibson, Paul; Ellsworth, Greta; Miller, Leslie; Hawkins, T. Lee-Ann; Hladunewich, Michelle; Rogowsky, Anna; Hui, Dini; Collins, Virginia; Delisle, Isabelle; Fanning, Cora; Demianczuk, Nestor; Khurana, Rshmi; Sia, Winnie; Marnoch, Catherine; Young, Carmen; Lux, Cheryl; Perreault, Sophie; Tremblay, Valerie; Desindes, Sophie; Côté, Anne-Marie; Dagenais, Veronique; Clark, Heather; O'Shea, Elaine; White, Ruth Rennicks; Gandhi, Shital; Martin, Mary-Jean; Brush, Cheryl; Seaward, Gareth; Newstead-Angel, Jill; Brandt, Judy; Martel, Jocelyne; Mytopher, Kristine; Buschau, Elise; Keely, Erin; Waddell, Patti; Shachkina, Svetlana; Karovitch, Alan; Anderson, Robert; Koenig, Nicole; Yong, Theresa; Vasiliou, Marie; Johnson, Peri; Allan, Beth; Natale, Renato; Kennedy, Laura; Opatrny, Lucie; Lavigne, Lorraine; Carson, George; Kelly, Sheila; Crane, Joan; Hutchens, Donna; Kusanovic, Juan Pedro; Figueroa, Christian; Neculman, Karla Silva; Ortiz, Juan Andres; Vargas, Paula; Ferrand, Pedro; Carrillo, Jorge; Borrero, Rodrigo Cifuentes; Gallo, Dahiana Marcela; Moreno, Luisa Fernanda; Kirss, Fred; Rull, Kristiina; Kirss, Anne; Major, Tamas; Fodor, Andrea; Bartha, Tunde; Hallak, Mordechai; Aslih, Nardin; Anabousi-Murra, Saja; Pri-Or, Ester; Harel, Linda; Siev, Sima; Hakim, Marwan; Khoury, Christina Simona; Hamati, Najla; El-Zibdeh, Mazen; Yousef, Lama; Hughes, Ruth; Leishman, Di; Pullar, Barbra; Farrant, Matthew; Swiatkowska-Freund, Malgorzata; Preis, Krzysztof; Traczyk-Los, Anette Aleksandra; Partyka, Anna; Preis-Orlikowska, Joanna; Lukaszuk, Mariusz; Krasomski, Grzegorz; Krekora, Michael; Kedzierska-Markowicz, Anna; Zych-Krekora, Katarzyna; Breborowicz, Grzegorz H.; Dera-Szymanowska, Anna; Bakker, Jannet; Akkermans, Joost; van den Akker, Eline; Logtenberg, Sabine; Koenen, Steven; de Reus, Maartje; Borman, David; Oudijk, Martijn A.; Bolte, Annemiek; Verfaille, Viki; Graaf, Bart; Porath, Martina; Verhoeven, Corine; Franssen, Maureen T.M.; Ulkeman, Lida; Hamming, Ineke; Keurentjes, Jose H.M.; van der Wal, Ina; Bijvank, S.W.A. Nij; Lutjes, A.A.; Visser, Henricus; Scheepers, Hubertina Catharina Johanna; van Beek, Erik; van Dam, Coby; van den Berg-Swart, Kathy; Pernet, Paula; van der Goes, Birgit; Schuitemaker, Nico; Kleiverda, Gunilla; van Alphen, Marcel; Rosman, Ageeth; Gaugler-Senden, Ingrid; Linders, Marieke; Nelson-Piercy, Catherine; Briley, Annette; Soh, May Ching; Harding, Kate; Tarft, Hayley; Churchill, David; Cheshire, Katherine; Icke, Julia; Ghosh, Mausumi; Thornton, James; Toomassi, Yvonne; Barker, Karen; Fisher, Joanne; Grace, Nicky; Green, Amanda; Gower, Joanne; Molnar, Anna; Parameshwaran, Shobhana; Simm, Andrew; Bugg, George; Davis, Yvette; Desphande, Ruta; Gunn, Yvette; Houda, Mohammed; Jones, Nia; Waugh, Jason; Allan, Carly; Waring, Gareth; Walkinshaw, Steve A.; Pascall, Angela; Clement-Jones, Mark; Dower, Michelle; Houghton, Gillian; Longworth, Heather; Purewal, Tej; Tuffnell, Derek; Farrar, Diane; Syson, Jennifer; Butterfield, Gillian; Jones, Vicky; Palethorpe, Rebecca; Germaine, Tracey; Habiba, Marwan; Lee, Debbie; Eniola, Olufemi; Blake, Lynne; Khan, Jane; Cameron, Helen M.; Hinshaw, Kim; Bargh, Amanda; Walton, Eileen; Sorinola, Olanrewaju; Guy, Anna; D'Souza, Zoe; Gabriel, Rhiannon; Williams, Jo; Hollands, Heidi; Jibodu, Olujimi; Collier, Sara; Tottie, Pauline; Oxby, Claire; Dwyer, James; Majoko, Franz; Goldring, Helen; Jones, Sharon; Cresswell, Janet; Underwood, Louise; Kelly-Baxter, Mary; Robinson, Rebecca; Anumba, Dilly; Chamberlain, Anne; Pye, Clare; Tower, Clare; Woods, Sue; Horrocks, Lisa; Prichard, Fiona; Moorhead, Lynsey; Lee, Sarah; Stephens, Louise; Taylor, Cara; Thomas, Suzanne; Whitworth, Melissa; Myers, Jenny; Knox, Ellen; Freitas, Katie; Kilby, Mark; Cotterill, Amanda; Abdo, Khalil; Rigby, Katrina; Butler, Julie; Crosfill, Fiona; Hughes, Sean; Prashar, Sanjeev; Soydemir, Fatimah; Ashworth, Janet; Mycock, Lorraine; Smith, Jill; Ikomi, Amaju; Goodsell, Kerry; Byrne, Jean; Masuku, Maxwell; Pilcher, Alice; Khandelwal, Meena; Simpkins, Gunda; Iavicoli, Michelle; Kim, Yon Sook; Fischer, Richard; Perry, Robin; Chang, Eugene Y.; Saunders, Tamara D.; Oswald, Betty W.; Zaks, Kristin D.; Rana, Sarosh; McCullough, Dawn; Sfakianaki, Anna; Danton, Cheryl; Kustan, Erin; Coraluzzi, Luisa; How, Helen; Waldon, Christina; Livingston, Jeffrey; Jackson, Sherry; Greene, Lisa; Shah, Dinesh; Tolosa, Jorge E.; Rincon, Monica; Pereira, Leonardo; Lawrence, Amy E.; Snyder, Janice E.; Armstrong, D. Michael; Blue, Teresa; Hester, Austin; Salisbury, Kathryn;
• Is Part Of: Hypertension. Volume 71:Issue 6(2018:Jun.)
• Publication Date: 2018-06
• Subjects: blood pressure -- fetal growth restriction -- humans -- hypertension, pregnancy-induced -- preeclampsia -- pregnancy outcome; Hypertension -- Periodicals; Hypertension -- Treatment -- Periodicals; 616.132005
• DOI: 10.1161/HYPERTENSIONAHA.117.10689
• Languages: English
• ISSNs: 0194-911X

Abstract

Abstract : For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight <10th centile ( P interaction =0.005), but more preterm birth ( P interaction =0.043), and no effect on perinatal death or high-level neonatal care >48 hours ( P interaction =0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks ( P interaction =0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes. Clinical Trial Registration—: URL:https://www.isrctn.com . Unique identifier: ISRCTN71416914. Abstract : Supplemental Digital Content is available in the text.