Laura A Magee1, Joel Singer2, Terry Lee3, Richard J McManus4, Sarah Lay-Flurrie4, Evelyne Rey5, Lucy C Chappell6, Jenny Myers7, Alexander G Logan8, Peter von Dadelszen6. 1. Department of Women and Children's Health, King's College London, UK. Electronic address: Laura.A.Magee@kcl.ac.uk. 2. School of Population and Public Health, Centre for Health Evaluation and Outcome Science, Providence Health Care Research Institute, University of British Columbia, Vancouver, Canada. 3. Centre for Health Evaluation and Outcome Science, Providence Health Care Research Institute, University of British Columbia, Vancouver, Canada. 4. Nuffield Department of Primary Care Health Sciences, University of Oxford, UK. 5. Departments of Medicine and Obstetrics and Gynaecology, Université de Montreal, Canada. 6. Department of Women and Children's Health, King's College London, UK. 7. Division of Developmental Biology and Medicine, Manchester Maternal & Fetal Health Research Centre, UK. 8. Department of Medicine, University of Toronto, Canada.
Abstract
OBJECTIVE: To examine the relationship between pregnancy outcomes and BP level and variability. DESIGN: Secondary analysis of CHIPS trial data (Control of Hypertension In Pregnancy Study, NCT01192412). SETTING: International. POPULATION OR SAMPLE: Women with chronic or gestational hypertension. METHODS: BP measurement was standardised in outpatient clinics. Adjusted (including for allocated group) mixed effects logistic regression was used to assess relationships between major CHIPS outcomes and both BP level (mean of clinic readings) and visit-to-visit within-participant BP variability (standard deviation and average real variability of absolute successive difference of BP values). BP values 7-28 days prior to outcomes (or birth for perinatal outcomes) were excluded in sensitivity analyses. MAIN OUTCOME MEASURES: Major CHIPS outcomes. RESULTS: Among 961 (97.4%) women, higher BP level was associated with more adverse maternal and perinatal outcomes (usually at p < 0.001) except for serious maternal complications. Among 913 (92.5%) women with at least two post-randomisation outpatient visits, higher BP variability was associated with increased odds of severe hypertension and pre-eclampsia (usually at p < 0.01). Sensitivity analyses suggested reverse causality for these maternal outcomes, but greater diastolic BP variability may have been associated with fewer adverse perinatal outcomes. CONCLUSIONS: Higher BP is an adverse prognostic marker, regardless of target BP. While the association between higher BP variability and severe hypertension and pre-eclampsia may be related to higher BP at diagnosis, our results suggest a possible advantage of BP variability for the fetus, through undefined mechanisms. TWEETABLE ABSTRACT: Higher blood pressure (BP) is associated with more adverse pregnancy outcomes, but higher BP variability may be good for the baby.
OBJECTIVE: To examine the relationship between pregnancy outcomes and BP level and variability. DESIGN: Secondary analysis of CHIPS trial data (Control of Hypertension In Pregnancy Study, NCT01192412). SETTING: International. POPULATION OR SAMPLE: Women with chronic or gestational hypertension. METHODS: BP measurement was standardised in outpatient clinics. Adjusted (including for allocated group) mixed effects logistic regression was used to assess relationships between major CHIPS outcomes and both BP level (mean of clinic readings) and visit-to-visit within-participant BP variability (standard deviation and average real variability of absolute successive difference of BP values). BP values 7-28 days prior to outcomes (or birth for perinatal outcomes) were excluded in sensitivity analyses. MAIN OUTCOME MEASURES: Major CHIPS outcomes. RESULTS: Among 961 (97.4%) women, higher BP level was associated with more adverse maternal and perinatal outcomes (usually at p < 0.001) except for serious maternal complications. Among 913 (92.5%) women with at least two post-randomisation outpatient visits, higher BP variability was associated with increased odds of severe hypertension and pre-eclampsia (usually at p < 0.01). Sensitivity analyses suggested reverse causality for these maternal outcomes, but greater diastolic BP variability may have been associated with fewer adverse perinatal outcomes. CONCLUSIONS: Higher BP is an adverse prognostic marker, regardless of target BP. While the association between higher BP variability and severe hypertension and pre-eclampsia may be related to higher BP at diagnosis, our results suggest a possible advantage of BP variability for the fetus, through undefined mechanisms. TWEETABLE ABSTRACT: Higher blood pressure (BP) is associated with more adverse pregnancy outcomes, but higher BP variability may be good for the baby.
Authors: Vesna D Garovic; Ralf Dechend; Thomas Easterling; S Ananth Karumanchi; Suzanne McMurtry Baird; Laura A Magee; Sarosh Rana; Jane V Vermunt; Phyllis August Journal: Hypertension Date: 2021-12-15 Impact factor: 9.897
Authors: Laura A Magee; Jeffrey Bone; Salwa Banoo Owasil; Joel Singer; Terry Lee; Mrutunjaya B Bellad; Shivaprasad S Goudar; Alexander G Logan; Salésio E Macuacua; Ashalata A Mallapur; Hannah L Nathan; Rahat N Qureshi; Esperança Sevene; Andrew H Shennan; Anifa Valá; Marianne Vidler; Zulfiqar A Bhutta; Peter von Dadelszen Journal: Hypertension Date: 2021-03-29 Impact factor: 10.190