American College of Cardiology and American Heart Association blood pressure categories—a systematic review of the relationship with adverse pregnancy outcomes in the first half of pregnancy

Slade, Laura J.; Mistry, Hiten D.; Bone, Jeffrey N; Wilson, Milly; Blackman, Maya; Syeda, Nuhaat; Dadelszen, Peter von; Magee, Laura A.

doi:10.1016/j.ajog.2022.10.004

Cited by 13 publications

(7 citation statements)

References 55 publications

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“…In our meta‐analysis (23 studies, 734 377 women), a BP threshold ≥140/90 mmHg was useful to rule‐in development of pre‐eclampsia (positive LRs ≥5.0), 4 eclampsia, stroke or maternal ICU admission, consistent with an increased risk of adverse pregnancy outcomes associated with chronic hypertension 1 . In the present study, at <20 weeks’ gestation, a BP ≥140/90 was just below the threshold for being useful as a diagnostic test for pre‐eclampsia (+LR = 4.40).…”

Section: Discussionmentioning

confidence: 85%

“…The ACC/AHA Task Force on Clinical Practice Guidelines called for investigations into use of these lower BP thresholds in pregnancy. Systematic reviews have disclosed an association between these lower BP thresholds and heightened risk of adverse pregnancy outcomes, for BP values measured either before 20 +0 weeks’ gestation or at ≥20 +0 weeks’ gestation 4,5 . However, none of the BP thresholds <140/90 mmHg demonstrated diagnostic test properties reflective of a useful ‘rule‐out’ or ‘rule‐in’ test for development of adverse pregnancy outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Blood pressure measurement and adverse pregnancy outcomes: A cohort study testing blood pressure variability and alternatives to 140/90 mmHg

Wilson,

Bone,

Slade

et al. 2023

BJOG

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ObjectiveTo examine the association with adverse pregnancy outcomes of: (1) American College of Cardiology/American Heart Association blood pressure (BP) thresholds, and (2) visit‐to‐visit BP variability (BPV), adjusted for BP level.DesignAn observational study.SettingAnalysis of data from the population‐based UK Southampton Women's Survey (SWS).Population or sample3003 SWS participants.MethodsGeneralised estimating equations were used to estimate crude and adjusted relative risks (RRs) of adverse pregnancy outcomes by BP thresholds, and by BPV (as standard deviation [SD], average real variability [ARV] and variability independent of the mean [VIM]). Likelihood ratios (LRs) were calculated to evaluate diagnostic test properties, for BP at or above a threshold, compared with those below.Main outcome measuresGestational hypertension, severe hypertension, pre‐eclampsia, preterm birth (PTB), small‐for‐gestational‐age (SGA) infants, neonatal intensive care unit (NICU) admission.ResultsA median of 11 BP measurements were included per participant. For BP at ≥20 weeks’ gestation, higher BP was associated with more adverse pregnancy outcomes; however, only BP <140/90 mmHg was a good rule‐out test (negative LR <0.20) for pre‐eclampsia and BP ≥140/90 mmHg a good rule‐in test (positive LR >8.00) for the condition. BP ≥160/110 mmHg could rule‐in PTB, SGA infants and NICU admission (positive LR >5.0). Higher BPV (by SD, ARV, or VIM) was associated with gestational hypertension, severe hypertension, pre‐eclampsia, PTB, SGA and NICU admission (adjusted RRs 1.05–1.39).ConclusionsWhile our findings do not support lowering the BP threshold for pregnancy hypertension, they suggest BPV could be useful to identify elevated risk of adverse outcomes.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Blood pressure measurement and adverse pregnancy outcomes: A cohort study testing blood pressure variability and alternatives to 140/90 mmHg

Wilson,

Bone,

Slade

et al. 2023

BJOG

Self Cite

View full text Add to dashboard Cite

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“…Recent studies concluded that lowering the diagnostic threshold for chronic hypertension would not assist clinicians in identifying women at heightened risk for preeclampsia and adverse pregnancy outcomes. (21) Medication for the hypertensive disorder of pregnancy should be considered when the SBP reaches 160 mmHg and/or DBP 110 mmHg. The definition of stage 2 hypertension was beneficial in identifying women with higher risks of adverse outcomes (i.e., preeclampsia), who were advised on how to prevent preeclampsia in advance of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…( 14) However, there is not enough evidence to support the efficacy of lower blood pressure thresholds for identifying women at heightened risk for preeclampsia. (17)(18)(19)(20)(21) The risks of preeclampsia were considered to be screened based on maternal risk factors. (22) Major maternal metabolic risk factors such as being overweight/obese increase the risks of gestational hypertensive disorders.…”

Section: Introductionmentioning

confidence: 99%

Impact of metabolic risks on preeclampsia among women with different early-pregnancy blood pressures based on 2017 AHA Guidelines: A retrospective study

Lin,

Wei,

Wang

et al. 2023

Preprint

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Objective A blood pressure (BP) of 120-140/80-90 mmHg at <20 weeks’ gestation is associated with risks for preeclampsia. We aimed to explore the effect of maternal metabolic risk factors on the strength of the association between blood pressure thresholds based on 2017 American Heart Association (AHA) guidelines and preeclampsia. Design Retrospective cohort study. Setting The reproductive center is based in Shanghai, China. Populationor Sample Data from 78,016 women enrolled between 2014 and 2019 from the medical record system of the center were used. Methods This retrospective cohort study included 78,016 participants. Preeclampsia prevalence was analyzed among women of four BP categories, stratified by maternal BMI and TG. Main outcome measures Incidence of preeclampsia Results Maternal BMI and TG showed a dose-response superimposed impact on the relationships between BPs and preeclampsia rates. Although heightened risks for preeclampsia were found in women with normal BMI (18.5-<25 kg/m2) and TG (<90th, 2.04 mM) women at a BP of 120-140 /80-90 mmHg, women with obesity (BMI ≥ 25 kg/m2) and (or) high TG (≥ 90th) showed higher rates of preeclampsia. The preeclampsia risk was the highest in women with obesity and high TG at a BP of 130-140/80-90 mmHg and over 140/90 mmHg, which was 6-fold, and 13-fold greater than normotensive women with normal BMI and TG respectively. Conclusion Obesity and (or) high TG tended to strengthen the association between BP over 130/80 mmHg and risk of preeclampsia.

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“…18 There is some evidence to suggest worse pregnancy outcomes associated with stage 1 hypertension, 12,19 although two recent meta-analyses did not find that lowering BP below 140/90 mm Hg improved risk prediction. 20,21 Therefore, through a secondary analysis of the original CHAP trial, we sought to evaluate the association between mean maternal BP below130/80 mm Hg, compared with 130-139 mm Hg systolic or 80-89 mm Hg diastolic, and maternal and perinatal outcomes.…”

mentioning

confidence: 99%

Perinatal Outcomes Associated With Management of Stage 1 Hypertension

Bailey,

Tita,

Leach

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To evaluate the association between maternal blood pressure (BP) below 130/80 mm Hg compared with 130–139/80–89 mm Hg and pregnancy outcomes. METHODS: We conducted a planned secondary analysis of CHAP (Chronic Hypertension and Pregnancy), an open label, multicenter, randomized controlled trial. Participants with mean BP below 140/90 mm Hg were grouped as below 130/80 mm Hg compared with 130–139/80–89 mm Hg by averaging postrandomization clinic BP throughout pregnancy. The primary composite outcome was preeclampsia with severe features, indicated preterm birth before 35 weeks of gestation, placental abruption, or fetal or neonatal death. The secondary outcome was small for gestational age (SGA). RESULTS: Of 2,408 patients in CHAP, 2,096 met study criteria; 1,328 had mean BP 130–139/80–89 mm Hg and 768 had mean BP below 130/80 mm Hg. Participants with mean BP below 130/80 mm Hg were more likely to be older, on antihypertensive medication, in the active treatment arm, and to have lower BP at enrollment. Mean clinic BP below 130/80 mm Hg was associated with lower frequency of the primary outcome (16.0% vs 35.8%, adjusted relative risk 0.45; 95% CI 0.38–0.54) as well as lower risk of severe preeclampsia and indicated birth before 35 weeks of gestation. There was no association with SGA. CONCLUSION: In pregnant patients with mild chronic hypertension, mean BP below 130/80 mm Hg was associated with improved pregnancy outcomes without increased risk of SGA. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02299414.

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American College of Cardiology and American Heart Association blood pressure categories—a systematic review of the relationship with adverse pregnancy outcomes in the first half of pregnancy

Cited by 13 publications

References 55 publications

Blood pressure measurement and adverse pregnancy outcomes: A cohort study testing blood pressure variability and alternatives to 140/90 mmHg

Blood pressure measurement and adverse pregnancy outcomes: A cohort study testing blood pressure variability and alternatives to 140/90 mmHg

Impact of metabolic risks on preeclampsia among women with different early-pregnancy blood pressures based on 2017 AHA Guidelines: A retrospective study

Perinatal Outcomes Associated With Management of Stage 1 Hypertension

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