Tight control of blood pressure in pregnant women with non-severe hypertension: expectations for decreasing adverse maternal and fatal pregnancy outcomes

It has been controversial regarding blood pressure (BP) levels at which antihypertensive drug therapy should be started, and the adequate Blood pressure goal to be achieved following antihypertensive drug therapy in women with hypertensive disorders of pregnancy (HDP), which includes chronic hypertension (CH) as well as hypertension occurring at or after 20 weeks of gestation. The Japan Society for the Study of Hypertension in Pregnancy (JSSHP) committee previously recommended that ● antihypertensive drug therapy should be initiated for pregnant women with severe hypertension (more than 160/110 mmHg), ● and BP should be maintained at 140–160/90–110 mmHg However, considering the recent recommendations of other guidelines like the International Society for Study of Hypertension in Pregnancy, and National Institute for Health and Care excellence, and landmark trials like Control of Hypertension in Pregnancy Study (CHIPS) study. The Japanese committee has changed the recommendation in 2021 to following ● antihypertensive drug therapy should be used in pregnant women with severe hypertension, for whom BP levels equal to or more than 160/110 mmHg are repeatedly observed; however, it is possible to start antihypertensive drug therapy in pregnant women with BP levels that are ≥140/90 mmHg at the discretion of attending physicians ● the BP goal following antihypertensive drug therapy in pregnant women with hypertension should be <130/85 Now there have been concerns that tight control of BP in pregnancy might be associated with the occurrence of non-reassuring fetal status (NRFS) and/or fetal growth restriction (FGR). In a meta-analysis of 45 randomized controlled trials (RCTs) including 3773 women with mild-to-moderate pregnancy hypertension, in which either placebo or antihypertensive therapy was administered to controls, the antihypertensive therapy was associated with higher incidence rates of small-for-gestational-age (SGA) infants as well as lower mean birthweight. In another meta-analysis of RCT including 63 trials with 5909 women, the use of antihypertensive drugs had no effect on the risk of small-for-gestational-age SGA, however, in the most recent guideline of the International Society for the Study of Hypertension in Pregnancy (ISSHP), it is recommended that the target BP for antihypertensive therapy should be a DBP of 85 mmHg, regardless of the SBP. Thus warranting further studies on tight control of BP in Pregnancy and its benefit. Dear Doctors as I sign off with this podcast series, I hope you liked my topics and podcast. Thanks for listening and wish you all good health. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.