Effects of Antihypertensive Therapy During Pregnancy on Postpartum Blood Pressure Control

Samantha L Martin¹, Hui-Chien Kuo, Kim Boggess, Lorraine Dugoff, Baha Sibai, Kirsten Lawrence, Brenna L Hughes, Joseph Bell, Kjersti Aagaard, Kelly S Gibson, David M Haas, Lauren Plante, Torri D Metz, Brian M Casey, Sean Esplin, Sherri Longo, Matthew Hoffman, George R Saade, Janelle Foroutan, Methodius G Tuuli, Michelle Y Owens, Hyagriv N Simhan, Heather A Frey, Todd Rosen, Anna Palatnik, Susan Baker, Phyllis August, Uma M Reddy, Wendy Kinzler, Emily J Su, Iris Krishna, Nicki Nguyen, Mary E Norton, Daniel Skupski, Yasser Y El-Sayed, Dotun Ogunyemi, Zorina S Galis, Namasivayam Ambalavanan, Suzanne Oparil, Ronald Librizzi, Leonardo Pereira, Everett F Magann, Mounira Habli, Shauna Williams, Giancarlo Mari, Gabriella Pridjian, David S McKenna, Marc Parrish, Eugene Chang, Sarah Osmundson, JoAnne Quinones, Erika Werner, Jeff M Szychowski, Alan T N Tita; CHAP Consortium

Affiliations

Affiliation

¹ Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, University of Pennsylvania, Philadelphia, Pennsylvania, University of Texas at Houston, Houston, Texas, Columbia University, New York, New York, Duke University, Durham, North Carolina, St. Luke's University Health Network, Bethlehem, Pennsylvania, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, Metro Health/Case Western University, Cleveland, Ohio, Indiana University, Indianapolis, Indiana, Drexel University College of Medicine, Philadelphia, Pennsylvania, University of Utah Health, Salt Lake City, Utah, University of Texas Southwestern, Dallas, Texas, Intermountain Healthcare, Salt Lake City, Utah, Ochsner Health, New Orleans, Louisiana, University of Texas Medical Branch, Galveston, Texas, St. Peters University Hospital, New Brunswick, New Jersey, Washington University in St. Louis, St. Louis, Missouri, University of Mississippi Medical Center, Jackson, Mississippi, Magee Women's Hospital and University of Pittsburgh, Pittsburgh, Pennsylvania, The Ohio State University, Columbus, Ohio, Rutgers University-Robert Wood Johnson Medical School, Brunswick, New Jersey, Medical College of Wisconsin, Milwaukee, Wisconsin, University of South Alabama at Mobile, Mobile, Alabama, Weill Cornell University, New York City, New York, Yale University, New Haven, Connecticut, NYU Langone Hospital-Long Island, Mineola, New York, University of Colorado, Aurora, Colorado, Emory University, Atlanta, Georgia, Denver Health, Denver, Colorado, University of California, San Francisco, San Francisco, California, NewYork-Presbyterian Queens Hospital, Flushing, New York, Stanford University, Stanford, California, Arrowhead Regional Medical Center, Colton, California, Tulane University, New Orleans, Louisiana, Wright State University and Miami Valley Hospital, Dayton, Ohio, University of Kansas Medical Center, Kansas City, Kansas, Medical University of South Carolina, Charleston, South Carolina, Vanderbilt University School of Medicine, Nashville, Tennessee, and Tufts University School of Medicine, Boston, Massachusetts; Beaumont Hospital, Grand Rapids, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics, the Department of Pediatrics, and the Department of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama; the Christiana Care Center for Women's and Children Health Research, Newark, Delaware; Zuckerberg San Francisco General Hospital, San Francisco, California; the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland; Virtua Health, Marlton, New Jersey; Oregon Health and Science University, Portland, Oregon; the Department of Obstetrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; the Fetal Care Center of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, Ohio; the Department of Obstetrics, Gynecology and Women's Health, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey; Obstetrics and Gynecology/Maternal-Fetal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, Pennsylvania; and Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.

PMID: 39265175
DOI: 10.1097/AOG.0000000000005715

Randomized Controlled Trial

Effects of Antihypertensive Therapy During Pregnancy on Postpartum Blood Pressure Control

Samantha L Martin et al. Obstet Gynecol. 2024.

. 2024 Oct 1;144(4):536-542.

doi: 10.1097/AOG.0000000000005715.

Authors

Affiliation

¹ Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, University of Pennsylvania, Philadelphia, Pennsylvania, University of Texas at Houston, Houston, Texas, Columbia University, New York, New York, Duke University, Durham, North Carolina, St. Luke's University Health Network, Bethlehem, Pennsylvania, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, Metro Health/Case Western University, Cleveland, Ohio, Indiana University, Indianapolis, Indiana, Drexel University College of Medicine, Philadelphia, Pennsylvania, University of Utah Health, Salt Lake City, Utah, University of Texas Southwestern, Dallas, Texas, Intermountain Healthcare, Salt Lake City, Utah, Ochsner Health, New Orleans, Louisiana, University of Texas Medical Branch, Galveston, Texas, St. Peters University Hospital, New Brunswick, New Jersey, Washington University in St. Louis, St. Louis, Missouri, University of Mississippi Medical Center, Jackson, Mississippi, Magee Women's Hospital and University of Pittsburgh, Pittsburgh, Pennsylvania, The Ohio State University, Columbus, Ohio, Rutgers University-Robert Wood Johnson Medical School, Brunswick, New Jersey, Medical College of Wisconsin, Milwaukee, Wisconsin, University of South Alabama at Mobile, Mobile, Alabama, Weill Cornell University, New York City, New York, Yale University, New Haven, Connecticut, NYU Langone Hospital-Long Island, Mineola, New York, University of Colorado, Aurora, Colorado, Emory University, Atlanta, Georgia, Denver Health, Denver, Colorado, University of California, San Francisco, San Francisco, California, NewYork-Presbyterian Queens Hospital, Flushing, New York, Stanford University, Stanford, California, Arrowhead Regional Medical Center, Colton, California, Tulane University, New Orleans, Louisiana, Wright State University and Miami Valley Hospital, Dayton, Ohio, University of Kansas Medical Center, Kansas City, Kansas, Medical University of South Carolina, Charleston, South Carolina, Vanderbilt University School of Medicine, Nashville, Tennessee, and Tufts University School of Medicine, Boston, Massachusetts; Beaumont Hospital, Grand Rapids, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics, the Department of Pediatrics, and the Department of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama; the Christiana Care Center for Women's and Children Health Research, Newark, Delaware; Zuckerberg San Francisco General Hospital, San Francisco, California; the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland; Virtua Health, Marlton, New Jersey; Oregon Health and Science University, Portland, Oregon; the Department of Obstetrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; the Fetal Care Center of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, Ohio; the Department of Obstetrics, Gynecology and Women's Health, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey; Obstetrics and Gynecology/Maternal-Fetal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, Pennsylvania; and Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.

PMID: 39265175
DOI: 10.1097/AOG.0000000000005715

Abstract

Objective: To compare differences in postpartum blood pressure (BP) control (BP below 140/90 mm Hg) for participants with hypertension randomized to receive antihypertensive treatment compared with no treatment during pregnancy.

Methods: This study was a planned secondary analysis of a multicenter, open-label, randomized controlled trial (The CHAP [Chronic Hypertension and Pregnancy] trial). Pregnant participants with mild chronic hypertension (BP below 160/105 mm Hg) were randomized into two groups: active (antihypertensive treatment) or control (no treatment unless severe hypertension, BP 160/105 mm Hg or higher). Study outcomes were BP control below 140/90 mm Hg (primary) and medication nonadherence based on a composite score threshold (secondary) at the 6-week postpartum follow-up visit. Participants without follow-up BP measurements were excluded from analysis of the BP control outcome. Participants without health care professional-prescribed antihypertensives at delivery were excluded from the analysis of the adherence outcome. Multivariable logistic regression was used to adjust for potential confounders.

Results: Of 2,408 participants, 1,684 (864 active, 820 control) were included in the analysis. A greater percentage of participants in the active group achieved BP control (56.7% vs 51.5%; adjusted odds ratio [aOR] 1.22, 95% CI, 1.00-1.48) than in the control group. Postpartum antihypertensive prescription was higher in the active group (81.7% vs 58.4%, P <.001), and nonadherence did not differ significantly between groups (aOR 0.81, 95% CI, 0.64-1.03).

Conclusion: Antihypertensive treatment of mild chronic hypertension during pregnancy was associated with better BP control below 140/90 mm Hg in the immediate postpartum period.

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Conflict of interest statement

Financial Disclosure Lorraine Dugoff reports money was paid to her institution from Myriad, Natera, and Laboratory Holdings/Sequenom. Lauren Plante disclosed that she received payments from Cambridge Publishing for royalties for textbooks and from Taylor & Francis for royalties for textbooks. Torri D. Metz received UpToDate royalties for two topics on trial of labor after cesarean. Money was paid to her institution from Pfizer (site PI for phase III respiratory syncytial virus [RSV] vaccine trial and site PI for a COVID-19 vaccination trial in pregnancy). Hyagriv Simhan disclosed receiving payment from Organon and UpToDate. Heather Frey, Wendy Kinzler, and Everett Magann disclosed receiving payment from UpToDate. Sean Esplin disclosed receiving payment from Laborie/Clinical Innovations. Sherri Longo disclosed that her institution is a subside for UAB for the MFMU network. They have a grant with Tulane for the Center of Excellence_ IMPROVE initiative. They are a site for the CSOAP follow-up study and CHAP maternal and neonatal follow-up studies. Mary Norton disclosed receiving payment from Luna Genetics. Daniel Skupski disclosed receiving payment from Organon and Cooper Surgical. Eugene Chang disclosed receiving payment from Roche Diagnostics. Sarah Osmundson served on the board for the Society for Maternal-Fetal Medicine. Suzanne Operil is the Editor-in-Chief of Hypertension Reports and receives a stipend. Alan T.N. Tita's institution received funding from Pfizer. The other authors did not report any potential conflicts of interest.

References

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Effects of Antihypertensive Therapy During Pregnancy on Postpartum Blood Pressure Control

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Effects of Antihypertensive Therapy During Pregnancy on Postpartum Blood Pressure Control

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