Category: Hypertension
Poster Session IV
In the Chronic Hypertension and Pregnancy (CHAP) trial, there were fewer adverse pregnancy outcomes in patients treated to blood pressure (BP) goal < 140/90 mm Hg. Our objective was to assess the relationship between PP BP at hospital discharge and maternal morbidity. We hypothesized that BP < 140/90 would be associated with less maternal morbidity
Study Design: A secondary analysis of the open-label, multicenter, randomized (CHAP) trial in patients with mild chronic hypertension and singleton fetuses. Patients with a live birth ≥24w with data for BP and antihypertensive medication at discharge were included. BPs at discharge were used to stratify patients by BPs below and above 140/90. The primary outcome was a composite of maternal death or intensive care unit admission, stroke or encephalopathy, congestive heart failure, pulmonary edema, myocardial infarction, acute kidney injury, and length of PP hospital stay ≥4 days with secondary outcomes of PP readmission and antihypertensive use at the PP visit
Results:
1645 patients were included (68% of CHAP participants); 1156 had a discharge BP < 140/90 and 489 with BP ≥ 140/90. Groups were similar with the exceptions of race/ethnicity (p=0.006), and lower pre-existing diabetes (13 v 17%, P=0.049) and history of pre-eclampsia (27 v 34%, P=0.005) between BP < 140/90 vs BP ≥140/90 groups, respectively (Table 1). Patients with BP≥140/90 had similar primary composite outcome rates as BP < 140/90 (1.2 vs. 2.3%, P=0.12), but an increased rate of any PP preeclampsia (7.5 v 11.9%, P< 0.01), average length of stay (5.2 v 6.1 days, P< 0.01), and on an antihypertensive medication at the PP visit (65 v 84%, P< 0.01) (Table 2). Readmission rate was not different
Conclusion:
BP of ≥140/90 at discharge in PP patients with mild chronic hypertension was associated with an increased rate of PP pre-eclampsia and longer hospital stay. Our results suggest that patients with a discharge BP >140/90 should have heightened surveillance for PP preeclampsia. Evaluation of whether the goal BP in patients with CHTN after pregnancy should be < 140/90 should be considered in future studies
Kelly S. Gibson, MD (she/her/hers)
Division Director, Maternal Fetal Medicine
MetroHealth Medical Center/Case Western Reserve University
Cleveland, Ohio, United States