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. 2023 Sep;130(10):1275-1285.
doi: 10.1111/1471-0528.17465. Epub 2023 Apr 24.

Choosing blood pressure thresholds to inform pregnancy care in the community: An analysis of cluster trials

Peter von Dadelszen  1   2 , Jeffrey N Bone  2 , Akshdeep Sandhu  2 , J Mark Ansermino  3 , Rahat N Qureshi  4 , Charfudin Sacoor  5 , Esperança Sevene  5   6 , Jing Li  2 , Marianne Vidler  2 , Mrutyunjaya B Bellad  7 , Zulfiqar A Bhutta  4   8 , Dustin T Dunsmuir  3 , Shivaprasad S Goudar  7 , Ashalata A Mallapur  9 , Khátia Munguambe  4   5 , Guy A Dumont  3   10 , Laura A Magee  1   2 ; CLIP Trials Working Group
Affiliations

Choosing blood pressure thresholds to inform pregnancy care in the community: An analysis of cluster trials

Peter von Dadelszen et al. BJOG. 2023 Sep.

Abstract

Objective: To inform digital health design by evaluating diagnostic test properties of antenatal blood pressure (BP) outputs and levels to identify women at risk of adverse outcomes.

Design: Planned secondary analysis of cluster randomised trials.

Setting: India, Pakistan, Mozambique.

Population: Women with in-community BP measurements and known pregnancy outcomes.

Methods: Blood pressure was defined by its outputs (systolic and/or diastolic, systolic only, diastolic only or mean arterial pressure [calculated]) and level: normotension-1 (<135/85 mmHg), normotension-2 (135-139/85-89 mmHg), non-severe hypertension (140-149/90-99 mmHg; 150-154/100-104 mmHg; 155-159/105-109 mmHg) and severe hypertension (≥160/110 mmHg). Dose-response (adjusted risk ratio [aRR]) and diagnostic test properties (negative [-LR] and positive [+LR] likelihood ratios) were estimated.

Main outcome measures: Maternal/perinatal composites of mortality/morbidity.

Results: Among 21 069 pregnancies, different BP outputs had similar aRR, -LR, and +LR for adverse outcomes. No BP level (even normotension-1) was associated with low risk (all -LR ≥0.20). Across outcomes, risks rose progressively with higher BP levels above normotension-1. For each of maternal central nervous system events and stillbirth, BP ≥155/105 mmHg showed at least good diagnostic test performance (+LR ≥5.0) and BP ≥135/85 mmHg at least fair performance, similar to BP ≥140/90 mmHg (+LR 2.0-4.99).

Conclusions: In the community, normal BP values do not provide reassurance about subsequent adverse outcomes. Given the similar performance of BP cut-offs of 135/85 and 140/90 mmHg for hypertension, and 155/105 and 160/110 mmHg for severe hypertension, digital decision support for women in the community should consider using these lower thresholds.

Keywords: blood pressure thresholds; community; digital health; pregnancy.

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References

REFERENCES

    1. Magee LA, Nicolaides KH, von Dadelszen P. Preeclampsia. N Engl J Med. 2022;386(19):1817-32.
    1. Payne BA, Hutcheon JA, Ansermino JM, Hall DR, Bhutta ZA, Bhutta SZ, et al. A risk prediction model for the assessment and triage of women with hypertensive disorders of pregnancy in low-resourced settings: the miniPIERS (pre-eclampsia integrated estimate of RiSk) multi-country prospective cohort study. PLoS Med. 2014;11(1):e1001589. https://doi.org/10.1371/journal.pmed.1001589
    1. Saudan P, Brown MA, Buddle ML, Jones M. Does gestational hypertension become pre-eclampsia? Br J Obstet Gynaecol. 1998;105(11):1177-84. https://doi.org/10.1111/j.1471-0528.1998.tb09971.x
    1. von Dadelszen P, Payne B, Li J, Ansermino JM, Broughton Pipkin F, Cote AM, et al. Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model. Lancet. 2011;377(9761):219-27. https://doi.org/10.1016/S0140-6736(10)61351-7
    1. Wen T, Schmidt CN, Sobhani NC, Guglielminotti J, Miller EC, Sutton D, et al. Trends and outcomes for deliveries with hypertensive disorders of pregnancy from 2000 to 2018: a repeated cross-sectional study. BJOG. 2022;129(7):1050-60. https://doi.org/10.1111/1471-0528.17038

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