Less-Tight Control of Non-Severe BP in Pregnancy OK for Fetus

Less-Tight Control of Non-Severe BP
Less-Tight Control of Non-Severe BP

(HealthDay News) — When pregnant women have non-severe hypertension, more-intensive treatment doesn't seem to affect their babies, but it may lower the odds that mothers will develop severe hypertension. That's the conclusion of a clinical trial reported in the January 29 issue of the New England Journal of Medicine.

The findings are based on 987 pregnant women from 16 different countries who had hypertension. Half were randomly assigned to "tight" blood pressure control, and half to "less tight." For the tight-control group, the goal was to get their diastolic pressure to ≤85; for the less-tight group, the goal was ≤100. Treatment involved regular blood pressure checks and, for most women, medication – with the dose adjusted when needed. Most of the women took labetalol.

Laura Magee, MD, of the Child and Family Research Institute and the University of British Columbia in Vancouver, Canada, and colleagues found no significant between-group differences in the risk of pregnancy loss, high-level neonatal care, or overall maternal complications. However, 40.6% of women under looser blood pressure control eventually developed severe hypertension, while just 27.5% of women on the tighter regimen developed severe hypertension.

Magee told HealthDay that she believes the risk of severely high numbers is not acceptable if less-intensive treatment has no clear benefit for babies. "Before this study, I was for less-tight control," she noted. "Now I've changed my practice." Until now, studies on this issue have been small or lower-quality, according to Magee. She said current professional guidelines vary because of that lack of strong evidence.

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