Category: Hypertension
Poster Session I
ACOG uses systolic blood pressure (SBP) ≥140 or diastolic blood pressure (DBP) ≥90 to define chronic hypertension (CHTN). The American College of Cardiology (ACC) & American Heart Association (AHA) define CHTN at lower thresholds by SBP ≥130 or DBP ≥80. It remains unclear whether using more conservative guidelines in pregnancy improves identification of those at risk for gestational hypertension (GHTN) or preeclampsia (PRE). We sought to assess whether subjects with CHTN vs no CHTN based on AHA/ACC criteria had an increased risk for GHTN or PRE.
Study Design:
We conducted a retrospective cohort study utilizing a clinical database at a racially diverse, urban, safety-net hospital. Subjects ages 18-40 with singleton gestations & first trimester (Tri1) prenatal care were included. The cohort excluded those with CHTN based on ACOG criteria (BP ≥140/90 at ≤ 20 weeks). We redefined CHTN based on Tri1 SBP/DBP values using AHA/ACC criteria. Diagnoses of GHTN & PRE were based on ACOG criteria. Chi-square tests & multivariable logistic regression were performed.
Results:
Of N=3,354 subjects, 18% (n=630) were diagnosed with CHTN based on AHA/ACC criteria. Based on AHA/ACC criteria, those with CHTN vs those without had increased rates of GHTN (35.4% vs 20%, p< 0.001) & PRE (22.3% vs 10%, p< 0.001). Furthermore, based on AHA/ACC criteria, those with CHTN vs those without had an almost 2.0 fold higher odds of experiencing GHTN (AOR 1.8, 95% CI 1.4-2.2, p< 0.001) or PRE (AOR 2.2, 95% CI 1.8-2.9, p< 0.001); these data remained significant after controlling for age, race, Tri1 body mass index, pregestational diabetes, and substance use.
Conclusion:
In using lower threshold SBP/DBP values to diagnose CHTN in a racially diverse urban population, our data suggests an increased risk of developing GHTN/PRE among those who meet ACC/AHA hypertension criteria. Future studies need to consider whether diagnosis of CHTN in pregnancy should conform with AHA/ACC criteria, and if those with AHA/ACC based CHTN require the same preventative measures and interventions utilized by those diagnosed by ACOG criteria.
Raina Advani, MD (she/her/hers)
Resident
Emory University
Atlanta, Georgia, United States
Suchitra Chandrasekaran, MD, MSCE
Assistant Professor
Emory University
Atlanta, Georgia, United States