CHIPS
Trial question
What is the effect of less-tight control of hypertension during pregnancy?
Study design
Multi-center
Open label
RCT
Population
987 female patients.
Inclusion criteria: women at 14-34 weeks gestation with nonproteinuric preexisting or gestational hypertension.
Key exclusion criteria: proteinuria, used an ACEi at 14 weeks 0 days of gestation or later, contraindication to either trial group because of a preexisting condition, known multiple gestation or a fetus with a major anomaly or chromosomal abnormality, had plans to terminate the pregnancy,.
Interventions
N=493 less-tight control (target DBP, 100 mmHg).
N=488 tight control (target DBP, 85 mmHg).
Primary outcome
Rate of pregnancy loss or requirement for high-level neonatal care for > 48 hours during the first 28 postnatal days
31.4%
30.7%
31.4 %
23.5 %
15.7 %
7.8 %
0.0 %
Less-tight
control
Tight
control
No significant
difference ↔
No significant difference in the rate of pregnancy loss or requirement for high-level neonatal care for > 48 hours during the first 28 postnatal days (31.4% vs. 30.7%; aOR 1.02, 95% CI 0.77 to 1.35).
Secondary outcomes
Significant increase in serious maternal complications (3.7% vs. 2%; aOR 1.74, 95% CI 0.79 to 3.84).
Significant increase in severe hypertension (40.6% vs. 27.5%; aOR 1.8, 95% CI 1.34 to 2.38).
Conclusion
In women at 14-34 weeks gestation with nonproteinuric preexisting or gestational hypertension, less-tight control was not superior to tight control with respect to the rate of pregnancy loss or requirement for high-level neonatal care for > 48 hours during the first 28 postnatal days.
Reference
Magee LA, von Dadelszen P, Rey E et al. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med. 2015 Jan 29;372(5):407-17.
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