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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Influence of gestational age at initiation of antihypertensive therapy: Secondary analysis of CHIPS trial data (control of hypertension in pregnancy study)
Hypertension, Volume 71, No. 6, Year 2018
Notification
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Description
For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight <10th centile (Pinteraction=0.005), but more preterm birth (Pinteraction=0.043), and no effect on perinatal death or high-level neonatal care >48 hours (Pinteraction=0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks (Pinteraction=0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes. © 2018 The Authors.
Authors & Co-Authors
Mol, Ben Willem
Australia, Adelaide
The University of Adelaide
Australia, Adelaide
South Australian Health and Medical Research Institute
Singer, Joel
Canada, Vancouver
The University of British Columbia
Lee, Terry C.K.
Canada, Vancouver
The University of British Columbia
von Dadelszen, Peter
United Kingdom, London
King's College London
United Kingdom, London
St Thomas' Hospital
Ganzevoort, Wessel J.
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Asztalos, Elizabeth Vagi
Canada, Toronto
University of Toronto
Magee, Laura A.
United Kingdom, London
King's College London
United Kingdom, London
St Thomas' Hospital
Gafni, Amiram
Unknown Affiliation
Gruslin, Andreé
Unknown Affiliation
Helewa, Michael Elias
Unknown Affiliation
Hutton, Eileen K.
Unknown Affiliation
Logan, Alexander Gordon
Unknown Affiliation
Menzies, Jennifer M.
Unknown Affiliation
Moutquin, Jean Marie
Unknown Affiliation
Rey, Évelyne
Unknown Affiliation
Ross, Sue J.
Unknown Affiliation
Thornton, Jim G.
Unknown Affiliation
Duley, Lelia M.M.
Unknown Affiliation
Thorpe, Kevin E.
Unknown Affiliation
Mahomed, Kassam
Unknown Affiliation
Crowther, Caroline A.
Unknown Affiliation
Walters, Barry N.J.
Unknown Affiliation
Pennell, Craig Edward
Unknown Affiliation
Makris, Angela
Unknown Affiliation
Hennessy, Annemarie
Unknown Affiliation
Sass, Nelson
Unknown Affiliation
Moreira de Sa, Renato Augusto
Unknown Affiliation
Besel, Kate E.
Unknown Affiliation
Hladunewich, Michelle Adrienne
Unknown Affiliation
Fanning, Cora A.
Unknown Affiliation
Demianczuk, Nestor N.
Unknown Affiliation
Cǒté, Anne Marie
Unknown Affiliation
Seaward, Gareth
Unknown Affiliation
Keely, Erin Joanne
Unknown Affiliation
Carson, George D.
Unknown Affiliation
Crane, Joan M.G.
Unknown Affiliation
Hutchens, Donna
Unknown Affiliation
Carrillo, Jorge
Unknown Affiliation
Gallo, Dahiana Marcela
Unknown Affiliation
Major, Tamás
Unknown Affiliation
Harel, Linda
Unknown Affiliation
Siev, Sima
Unknown Affiliation
El-Zibdeh, Mazen Yousef
Unknown Affiliation
Verhoeven, Corine J.M.
Unknown Affiliation
Pernet, Paula J.M.
Unknown Affiliation
Gaugler-Senden, Ingrid P.M.
Unknown Affiliation
Nelson-Piercy, Catherine F.
Unknown Affiliation
Briley, Annette L.
Unknown Affiliation
Harding, Kate
Unknown Affiliation
Churchill, David N.
Unknown Affiliation
Bugg, George John
Unknown Affiliation
Jones, Nia Wyn
Unknown Affiliation
Allan, Carly
Unknown Affiliation
Walkinshaw, Stephen A.
Unknown Affiliation
Houghton, Gillian
Unknown Affiliation
Longworth, Heather L.
Unknown Affiliation
Tuffnell, Derek J.
Unknown Affiliation
Syson, Jennifer
Unknown Affiliation
Jones, Vicky
Unknown Affiliation
Cameron, Helen Mc D.
Unknown Affiliation
Sorinola, Olanrewaju O.
Unknown Affiliation
Hollands, Heidi J.
Unknown Affiliation
Majoko, Franz M.
Unknown Affiliation
Cresswell, Janet L.
Unknown Affiliation
Anumba, Dilly O.C.
Unknown Affiliation
Moorhead, Lynsey
Unknown Affiliation
Thomas, Suzanne
Unknown Affiliation
Myers, Jenny E.
Unknown Affiliation
Knox, Ellen M.
Unknown Affiliation
Kilby, Mark D.
Unknown Affiliation
Khandelwal, Meena
Unknown Affiliation
Rana, Sarosh
Unknown Affiliation
How, Helen Y.
Unknown Affiliation
Tolosa, Jorge E.
Unknown Affiliation
Pereira, Leonardo M.R.
Unknown Affiliation
Salisbury, Kathryn
Unknown Affiliation
Statistics
Citations: 23
Authors: 76
Affiliations: 7
Identifiers
Doi:
10.1161/HYPERTENSIONAHA.117.10689
ISSN:
0194911X
Research Areas
Maternal And Child Health
Noncommunicable Diseases
Sexual And Reproductive Health
Study Design
Randomised Control Trial
Participants Gender
Female