The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure?

Laura A. Magee; Peter von Dadelszen; Joel Singer; Terry Lee; Evelyne Rey; Susan Ross; Elizabeth Asztalos; Kellie E. Murphy; Jennifer Menzies; Johanna Sanchez; Amiram Gafni; Michael Helewa; Eileen Hutton; Gideon Koren; Shoo K. Lee; Alexander G. Logan; Wessel Ganzevoort; Ross Welch; Jim G. Thornton; Jean-Marie Moutquin; CHIPS Study Group

doi:10.1161/HYPERTENSIONAHA.116.07862

The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure?

Laura A. Magee, Peter von Dadelszen, Joel Singer, Terry Lee, Evelyne Rey, Susan Ross, Elizabeth Asztalos, Kellie E. Murphy, Jennifer Menzies, Johanna Sanchez, Amiram Gafni, Michael Helewa, Eileen Hutton, Gideon Koren, Shoo K. Lee, Alexander G. Logan, Wessel Ganzevoort, Ross Welch, Jim G. Thornton, Jean-Marie MoutquinCHIPS Study Group

Women & Children's Health

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Abstract

To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of textquotedblleftless tighttextquotedblright (target diastolic blood pressure [dBP] 100 mm Hg) versus textquotedbllefttighttextquotedblright control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for gt;48 hours) and secondary outcomes (serious maternal complications), birth weight lt;10th percentile, preeclampsia, delivery at lt;34 or lt;37 weeks, platelets lt;100texttimes109/L, elevated liver enzymes with symptoms, maternal length of stay >=10 days, and maternal readmission before 6 weeks postpartum. Three hundred and thirty-four (34.1 women in CHIPS developed severe hypertension that was associated with all outcomes examined except for maternal readmission (P=0.20): CHIPS primary outcome, birth weight lt;10th percentile, preeclampsia, preterm delivery, elevated liver enzymes (all Plt;0.001), platelets lt;100texttimes109/L (P=0.006), and prolonged hospital stay (P=0.03). The association between severe hypertension and serious maternal complications was seen only in less tight control (P=0.02). Adjustment for preeclampsia (464, 47.3 did not negate the relationship between severe hypertension and the CHIPS primary outcome (Plt;0.001), birth weight lt;10th percentile (P=0.005), delivery at lt;37 (Plt;0.001) or lt;34 weeks (Plt;0.001), or elevated liver enzymes with symptoms (P=0.02). Severe hypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preeclampsia co-occurrence.Clinical Trial RegistrationtextemdashURL: http://pre-empt.cfri.ca/. Unique identifier: ISRCTN 71416914. URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01192412.Novelty and Significance

Original language	English
Pages (from-to)	1153-1159
Number of pages	7
Journal	Hypertension
Volume	68
Issue number	5
Early online date	12 Sept 2016
DOIs	https://doi.org/10.1161/HYPERTENSIONAHA.116.07862
Publication status	Published - Nov 2016

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Magee, L. A., von Dadelszen, P., Singer, J., Lee, T., Rey, E., Ross, S., Asztalos, E., Murphy, K. E., Menzies, J., Sanchez, J., Gafni, A., Helewa, M., Hutton, E., Koren, G., Lee, S. K., Logan, A. G., Ganzevoort, W., Welch, R., Thornton, J. G., ... CHIPS Study Group (2016). The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure? Hypertension, 68(5), 1153-1159. https://doi.org/10.1161/HYPERTENSIONAHA.116.07862

@article{fb2055ad28e24d15a5653cebb83d7ce8,

title = "The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure?",

abstract = "To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of textquotedblleftless tighttextquotedblright (target diastolic blood pressure [dBP] 100 mm Hg) versus textquotedbllefttighttextquotedblright control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for gt;48 hours) and secondary outcomes (serious maternal complications), birth weight lt;10th percentile, preeclampsia, delivery at lt;34 or lt;37 weeks, platelets lt;100texttimes109/L, elevated liver enzymes with symptoms, maternal length of stay >=10 days, and maternal readmission before 6 weeks postpartum. Three hundred and thirty-four (34.1 women in CHIPS developed severe hypertension that was associated with all outcomes examined except for maternal readmission (P=0.20): CHIPS primary outcome, birth weight lt;10th percentile, preeclampsia, preterm delivery, elevated liver enzymes (all Plt;0.001), platelets lt;100texttimes109/L (P=0.006), and prolonged hospital stay (P=0.03). The association between severe hypertension and serious maternal complications was seen only in less tight control (P=0.02). Adjustment for preeclampsia (464, 47.3 did not negate the relationship between severe hypertension and the CHIPS primary outcome (Plt;0.001), birth weight lt;10th percentile (P=0.005), delivery at lt;37 (Plt;0.001) or lt;34 weeks (Plt;0.001), or elevated liver enzymes with symptoms (P=0.02). Severe hypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preeclampsia co-occurrence.Clinical Trial RegistrationtextemdashURL: http://pre-empt.cfri.ca/. Unique identifier: ISRCTN 71416914. URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01192412.Novelty and Significance",

author = "Magee, {Laura A.} and {von Dadelszen}, Peter and Joel Singer and Terry Lee and Evelyne Rey and Susan Ross and Elizabeth Asztalos and Murphy, {Kellie E.} and Jennifer Menzies and Johanna Sanchez and Amiram Gafni and Michael Helewa and Eileen Hutton and Gideon Koren and Lee, {Shoo K.} and Logan, {Alexander G.} and Wessel Ganzevoort and Ross Welch and Thornton, {Jim G.} and Jean-Marie Moutquin and {CHIPS Study Group}",

year = "2016",

month = nov,

doi = "10.1161/HYPERTENSIONAHA.116.07862",

language = "English",

volume = "68",

pages = "1153--1159",

journal = "Hypertension",

issn = "0194-911X",

publisher = "American Heart Association, Inc.",

number = "5",

}

Magee, LA , von Dadelszen, P, Singer, J, Lee, T, Rey, E, Ross, S, Asztalos, E, Murphy, KE, Menzies, J, Sanchez, J, Gafni, A, Helewa, M, Hutton, E, Koren, G, Lee, SK, Logan, AG, Ganzevoort, W, Welch, R, Thornton, JG, Moutquin, J-M & CHIPS Study Group 2016, 'The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure?', Hypertension, vol. 68, no. 5, pp. 1153-1159. https://doi.org/10.1161/HYPERTENSIONAHA.116.07862

TY - JOUR

T1 - The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study)

T2 - Is Severe Hypertension Just an Elevated Blood Pressure?

AU - Magee, Laura A.

AU - von Dadelszen, Peter

AU - Singer, Joel

AU - Lee, Terry

AU - Rey, Evelyne

AU - Ross, Susan

AU - Asztalos, Elizabeth

AU - Murphy, Kellie E.

AU - Menzies, Jennifer

AU - Sanchez, Johanna

AU - Gafni, Amiram

AU - Helewa, Michael

AU - Hutton, Eileen

AU - Koren, Gideon

AU - Lee, Shoo K.

AU - Logan, Alexander G.

AU - Ganzevoort, Wessel

AU - Welch, Ross

AU - Thornton, Jim G.

AU - Moutquin, Jean-Marie

AU - CHIPS Study Group

PY - 2016/11

Y1 - 2016/11

N2 - To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of textquotedblleftless tighttextquotedblright (target diastolic blood pressure [dBP] 100 mm Hg) versus textquotedbllefttighttextquotedblright control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for gt;48 hours) and secondary outcomes (serious maternal complications), birth weight lt;10th percentile, preeclampsia, delivery at lt;34 or lt;37 weeks, platelets lt;100texttimes109/L, elevated liver enzymes with symptoms, maternal length of stay >=10 days, and maternal readmission before 6 weeks postpartum. Three hundred and thirty-four (34.1 women in CHIPS developed severe hypertension that was associated with all outcomes examined except for maternal readmission (P=0.20): CHIPS primary outcome, birth weight lt;10th percentile, preeclampsia, preterm delivery, elevated liver enzymes (all Plt;0.001), platelets lt;100texttimes109/L (P=0.006), and prolonged hospital stay (P=0.03). The association between severe hypertension and serious maternal complications was seen only in less tight control (P=0.02). Adjustment for preeclampsia (464, 47.3 did not negate the relationship between severe hypertension and the CHIPS primary outcome (Plt;0.001), birth weight lt;10th percentile (P=0.005), delivery at lt;37 (Plt;0.001) or lt;34 weeks (Plt;0.001), or elevated liver enzymes with symptoms (P=0.02). Severe hypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preeclampsia co-occurrence.Clinical Trial RegistrationtextemdashURL: http://pre-empt.cfri.ca/. Unique identifier: ISRCTN 71416914. URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01192412.Novelty and Significance

AB - To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of textquotedblleftless tighttextquotedblright (target diastolic blood pressure [dBP] 100 mm Hg) versus textquotedbllefttighttextquotedblright control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for gt;48 hours) and secondary outcomes (serious maternal complications), birth weight lt;10th percentile, preeclampsia, delivery at lt;34 or lt;37 weeks, platelets lt;100texttimes109/L, elevated liver enzymes with symptoms, maternal length of stay >=10 days, and maternal readmission before 6 weeks postpartum. Three hundred and thirty-four (34.1 women in CHIPS developed severe hypertension that was associated with all outcomes examined except for maternal readmission (P=0.20): CHIPS primary outcome, birth weight lt;10th percentile, preeclampsia, preterm delivery, elevated liver enzymes (all Plt;0.001), platelets lt;100texttimes109/L (P=0.006), and prolonged hospital stay (P=0.03). The association between severe hypertension and serious maternal complications was seen only in less tight control (P=0.02). Adjustment for preeclampsia (464, 47.3 did not negate the relationship between severe hypertension and the CHIPS primary outcome (Plt;0.001), birth weight lt;10th percentile (P=0.005), delivery at lt;37 (Plt;0.001) or lt;34 weeks (Plt;0.001), or elevated liver enzymes with symptoms (P=0.02). Severe hypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preeclampsia co-occurrence.Clinical Trial RegistrationtextemdashURL: http://pre-empt.cfri.ca/. Unique identifier: ISRCTN 71416914. URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01192412.Novelty and Significance

U2 - 10.1161/HYPERTENSIONAHA.116.07862

DO - 10.1161/HYPERTENSIONAHA.116.07862

M3 - Article

SN - 0194-911X

VL - 68

SP - 1153

EP - 1159

JO - Hypertension

JF - Hypertension

IS - 5

ER -

The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure?

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