Treatment for Mild Chronic Hypertension during Pregnancy

This multicenter, randomized CHAP trial evaluated the efficacy and safety of treating mild chronic hypertension (blood pressure <160/100 mm Hg) during pregnancy. A total of 2,408 pregnant women with singleton fetuses (<23 weeks’ gestation) were assigned to active treatment (targeting blood pressure <140/90 mm Hg with labetalol or nifedipine) or standard care (treatment only for severe hypertension). The primary composite outcome (preeclampsia with severe features, preterm birth <35 weeks, placental abruption, or perinatal death) occurred in 30.2% of the active-treatment group vs. 37.0% in the control group (adjusted risk ratio, 0.82; 95% CI, 0.74–0.92; P<0.001). Active treatment reduced preeclampsia (24.4% vs. 31.1%) and preterm birth (27.5% vs. 31.4%) without increasing small for gestational age births (11.2% vs. 10.4%). Serious maternal or neonatal complications were rare and similar between groups. The trial concluded that treating mild chronic hypertension to a target of <140/90 mm Hg improves pregnancy outcomes without compromising fetal growth.

This multicenter, randomized CHAP trial evaluated the efficacy and safety of treating mild chronic hypertension (blood pressure <160/100 mm Hg) during pregnancy. A total of 2,408 pregnant women with singleton fetuses (<23 weeks’ gestation) were assigned to active treatment (targeting blood pressure <140/90 mm Hg with labetalol or nifedipine) or standard care (treatment only for severe hypertension). The primary composite outcome (preeclampsia with severe features, preterm birth <35 weeks, placental abruption, or perinatal death) occurred in 30.2% of the active-treatment group vs. 37.0% in the control group (adjusted risk ratio, 0.82; 95% CI, 0.74–0.92; P<0.001). Active treatment reduced preeclampsia (24.4% vs. 31.1%) and preterm birth (27.5% vs. 31.4%) without increasing small for gestational age births (11.2% vs. 10.4%). Serious maternal or neonatal complications were rare and similar between groups. The trial concluded that treating mild chronic hypertension to a target of <140/90 mm Hg improves pregnancy outcomes without compromising fetal growth.