Yet another evidence discourages antihypertensives for moderate/mild chronic hypertension in pregnancy

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Takeaway

  • Meta-analysis of pregnant women with mild to moderate chronic hypertension indicates that lowering of mean arterial pressure with antihypertensive therapies has no significant effects on risk for pre-eclampsia.
  • No significant reduction was observed for risk for small for gestational age (SGA) neonates too.

Why this matters

  • Guidelines have been reluctant to recommend antihypertensive medications for mild to moderate hypertension because of lack of evidence supporting improved perinatal outcomes.
  • Findings are concordant with a previous study that found no difference between a tight (85 mmHg) and less-tight (100 mmHg) diastolic BP control on risk for pre-eclampsia and SGA.

Study design

  • Meta-analysis evaluated 6 randomised controlled trials (RCTs) involving 495 pregnant women with mild to moderate chronic hypertension in pregnancy.
  • Funding: Fetal Medicine Foundation.

Key results

  • Mean arterial pressure was significantly lower in women who received antihypertensive therapy vs those who received placebo or no treatment (mean difference, −4.2 mmHg; P=.0005).
  • However, no significant reduction was observed in risk for pre-eclampsia (relative risk [RR], 1.03; P=.90) or SGA (RR, 1.01; P=.99).

Limitations

  • Risk for bias.
  • High heterogeneity among included studies.