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Less-tight versus tight control of hypertension in pregnancy

Magee, Laura A.; von Dadelszen, Peter; Rey, Evelyne; Ross, Susan; Asztalos, Elizabeth; Murphy, Kellie E.; Menzies, Jennifer; Sanchez, Johanna; Singer, Joel; Gafni, Amiram; Gruslin, Andrée; Helewa, Michael; Hutton, Eileen; Lee, Shoo K.; Lee, Terry; Logan, Alexander G.; Ganzevoort, Wessel; Welch, Ross; Thornton, Jim; Moutquin, Jean-Marie

Authors

Laura A. Magee

Peter von Dadelszen

Evelyne Rey

Susan Ross

Elizabeth Asztalos

Kellie E. Murphy

Jennifer Menzies

Johanna Sanchez

Joel Singer

Amiram Gafni

Andrée Gruslin

Michael Helewa

Eileen Hutton

Shoo K. Lee

Terry Lee

Alexander G. Logan

Wessel Ganzevoort

Ross Welch

JIM THORNTON jim.thornton@nottingham.ac.uk
Professor of Obstetrics and Gynaecology

Jean-Marie Moutquin



Abstract

BACKGROUND
The effects of less-tight versus tight control of hypertension on pregnancy complications are unclear.
METHODS
We performed an open, international, multicenter trial involving women at 14 weeks 0 days to 33 weeks 6 days of gestation who had nonproteinuric preexisting or gestational hypertension, office diastolic blood pressure of 90 to 105 mm Hg (or 85 to 105 mm Hg if the woman was taking antihypertensive medications), and a live fetus. Women were randomly assigned to less-tight control (target diastolic blood pressure, 100 mm Hg) or tight control (target diastolic blood pressure, 85 mm Hg). The composite primary outcome was pregnancy loss or high-level neonatal care for more than 48 hours during the first 28 postnatal days. The secondary outcome was serious maternal complications occurring up to 6 weeks post partum or until hospital discharge, whichever was later.
RESULTS
Included in the analysis were 987 women; 74.6% had preexisting hypertension. The primary-outcome rates were similar among 493 women assigned to less-tight control and 488 women assigned to tight control (31.4% and 30.7%, respectively; adjusted odds ratio, 1.02; 95% confidence interval [CI], 0.77 to 1.35), as were the rates of serious maternal complications (3.7% and 2.0%, respectively; adjusted odds ratio, 1.74; 95% CI, 0.79 to 3.84), despite a mean diastolic blood pressure that was higher in the less-tight-control group by 4.6 mm Hg (95% CI, 3.7 to 5.4). Severe hypertension (≥160/110 mm Hg) developed in 40.6% of the women in the less-tight-control group and 27.5% of the women in the tight-control group (P

Journal Article Type Article
Publication Date Jan 29, 2015
Journal New England Journal of Medicine
Print ISSN 0028-4793
Electronic ISSN 1533-4406
Publisher Massachusetts Medical Society
Peer Reviewed Peer Reviewed
Volume 372
Issue 5
APA6 Citation Magee, L. A., von Dadelszen, P., Rey, E., Ross, S., Asztalos, E., Murphy, K. E., …Moutquin, J. (2015). Less-tight versus tight control of hypertension in pregnancy. New England Journal of Medicine, 372(5), https://doi.org/10.1056/NEJMoa1404595
DOI https://doi.org/10.1056/NEJMoa1404595
Publisher URL http://www.nejm.org/doi/full/10.1056/NEJMoa1404595
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf
Additional Information Acceptance date is estimated.

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf





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