Early blood pressure control improves pregnancy outcome in primigravid women with mild hypertension

Abstract

Objective and design: The aim of this study was to evaluate treatment of mild to moderate hypertension (less than 170/110 mmHg) in pregnancy in a prospective, randomised, double-blind trial.

Setting and patients: Pregnancy outcome was studied for 52 primigravid women, managed in hospital from early in the third trimester.

Interventions: Patients were randomly allocated either to placebo or to active treatment (clonidine plus hydralazine).

Main outcome measures and results: Maternal deterioration dictated withdrawal from trial therapy for eight patients receiving placebo, but for only one receiving active treatment. Maternal proteinuria occurred only in the placebo group. Intention-to-treat analysis showed a significant increase in premature delivery for complications in the placebo group (P less than 0.05), despite active blood pressure treatment for those withdrawn from the group because of severe hypertension (170/110 mmHg or higher). Neonatal respiratory distress requiring intensive care occurred only in babies born to women in the placebo group. There were no perinatal deaths and no adverse effects of treatment in the neonates.

Conclusions: The study indicates that early control of mild hypertension in pregnancy can prevent progression to emergency premature delivery.