Article Impact Level: HIGH Data Quality: STRONG Summary of Cardiology, 46(5), 467–476. https://doi.org/10.1002/clc.24013 Dr. Armin Attar et al.
Points
- Controversy surrounds treating pregnant individuals with mild hypertension (140–159/90–109 mm Hg) despite recent clinical trials supporting intervention.
- A comprehensive meta-analysis of 12 trials involving 4461 pregnant women with mild to moderate hypertension clarifies the impact of pharmacological treatment on maternal and fetal outcomes.
- Antihypertensive treatment significantly improves seven out of 19 analyzed outcomes, including reduced risks of severe hypertension, preeclampsia, placental abruption, and neonatal mortality.
- Notably, the primary safety measure, small for gestational age, does not differ significantly between the treatment and control groups.
- The findings strongly support pharmacological treatment for mild hypertension during pregnancy, benefiting mothers and neonates while demonstrating minimal adverse effects on the fetus.
Summary
This research paper delves into the ongoing debate surrounding the management of mild hypertension in pregnant individuals, characterized by blood pressure levels within the range of 140–159/90–109 mm Hg. While existing guidelines refrain from universally advocating for pharmacological treatment in such cases, recent clinical trials have reported promising outcomes. This comprehensive meta-analysis’s primary objective is to clarify whether actively treating mild hypertension during pregnancy can lead to superior maternal and fetal results.
The study employed a rigorous systematic database search to identify all potential randomized controlled trials that investigated the effects of pharmacological treatment on maternal, fetal, and neonatal outcomes among mild hypertensive patients. A total of 12 trials, encompassing 4461 pregnant women diagnosed with mild to moderate hypertension (2395 in the intervention group and 2066 in the control group), were subjected to quantitative synthesis. The researchers utilized a random-effects model to calculate relative risk (RR) and 95% confidence intervals (CIs). The analysis unveiled that antihypertensive treatment yielded significant benefits in seven of the 19 evaluated outcomes, with the following risk reduction figures: severe hypertension (RR = 0.53; 95% CI = [0.38;0.75]), preeclampsia (RR = 0.71; 95% CI = [0.54; 0.93]), placental abruption (RR = 0.48; 95% CI = [0.26; 0.87]), changes in electrocardiogram (RR = 0.43; 95% CI = [0.25; 0.72]), renal impairment (RR = 0.42; 95% CI = [0.34; 0.51]), pulmonary edema (RR = 0.46; 95% CI = [0.25; 0.84]), and neonatal mortality (RR = 0.72; 95% CI = [0.57; 0.92]). Notably, the primary safety outcome, small for gestational age, exhibited no significant difference between the treatment and control groups (RR = 1.12; 95% CI = [0.80; 1.57]).
To summarize, this meta-analysis robustly supports the favorable impact of pharmacological treatment on mild hypertension during pregnancy, demonstrating improved outcomes for maternal and neonatal health. Furthermore, it highlights the absence of substantial adverse effects on the fetus, thereby advancing our understanding of the potential advantages of intervention in this specific clinical context. These findings hold significant implications for clinical practice and decision-making regarding managing mild hypertension in pregnant patients, ultimately contributing to enhanced maternal and fetal well-being.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24013
References Attar, A., Hosseinpour, A., & Moghadami, M. (2023). The impact of antihypertensive treatment of mild to moderate hypertension during pregnancy on maternal and neonatal outcomes: An updated meta‐analysis of randomized controlled trials. Clinical Cardiology, 46(5), 467–476. https://doi.org/10.1002/clc.24013
