Treating Hypertension in Pregnancy

This editorial discusses the rising prevalence of chronic hypertension in pregnancy, particularly among older and Black women in the U.S., and its associated risks for both mothers (e.g., preeclampsia, stroke) and fetuses (e.g., preterm birth, growth restriction). It highlights the Chronic Hypertension and Pregnancy (CHAP) trial, a multicenter study comparing active antihypertensive treatment (targeting blood pressure <140/90 mm Hg) with standard care (treatment only for severe hypertension) in 2,408 pregnant women with mild hypertension. Active treatment significantly reduced the primary composite outcome (preeclampsia with severe features, preterm birth <35 weeks, placental abruption, or perinatal death; 30.2% vs. 37.0%, adjusted risk ratio 0.82, P<0.001) without increasing risks of small-for-gestational age births. The editorial cautiously notes the potential reduction in preeclampsia rates a novel finding but emphasizes the need for confirmation due to multiple secondary outcomes. The results support reconsidering treatment thresholds for mild hypertension in pregnancy to improve maternal and fetal outcomes.

This editorial discusses the rising prevalence of chronic hypertension in pregnancy, particularly among older and Black women in the U.S., and its associated risks for both mothers (e.g., preeclampsia, stroke) and fetuses (e.g., preterm birth, growth restriction). It highlights the Chronic Hypertension and Pregnancy (CHAP) trial, a multicenter study comparing active antihypertensive treatment (targeting blood pressure <140/90 mm Hg) with standard care (treatment only for severe hypertension) in 2,408 pregnant women with mild hypertension. Active treatment significantly reduced the primary composite outcome (preeclampsia with severe features, preterm birth <35 weeks, placental abruption, or perinatal death; 30.2% vs. 37.0%, adjusted risk ratio 0.82, P<0.001) without increasing risks of small-for-gestational age births. The editorial cautiously notes the potential reduction in preeclampsia rates a novel finding but emphasizes the need for confirmation due to multiple secondary outcomes. The results support reconsidering treatment thresholds for mild hypertension in pregnancy to improve maternal and fetal outcomes.