What BP target is appropriate for pregnant patients with mild chronic hypertension?
Active treatment to a lower blood pressure goal (< 140/90 mm Hg) can improve pregnancy outcomes without increasing maternal or fetal risk.
PRACTICE CHANGER
Treat mild chronic hypertension during pregnancy to a target of < 140/90 mm Hg to reduce the risk for adverse pregnancy outcomes.
STRENGTH OF RECOMMENDATION
B: Based on a single high-quality randomized controlled trial (RCT).1
Tita AT, Szychowski JM, Boggess K, et al; Chronic Hypertension and Pregnancy (CHAP) Trial Consortium. Treatment for mild chronic hypertension during pregnancy. N Engl J Med. 2022;386:1781-1792. doi: 10.1056/NEJMoa2201295
CAVEATS
Patient characteristics and medication choices were limited
This trial does not identify a BP goal for patients who are at highest risk for complications of hypertension or who already have been given a diagnosis of a growth-restricted fetus, as those patients were excluded.
Most patients in the trial who required medications received labetalol or extended-release nifedipine. It is unclear if other medications would produce similar outcomes.
CHALLENGES TO IMPLEMENTATION
Limited challenges anticipated
There should be limited challenges to implementation.
