The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study)

Magee, Laura A.; Dadelszen, Peter von; Singer, Joel; Lee, Terry; Rey, Évelyne; Ross, Susan; Asztalos, Elizabeth; Murphy, Kellie; Menzies, Jennifer; Sanchez, Johanna; Gafni, Amiram; Helewa, Michael; Hutton, Eileen K.; Koren, Gideon; Lee, Shoo K.; Logan, Alexander G.; Ganzevoort, Wessel; Welch, Ross; Thornton, Jim; Moutquin, Jean‐Marie

doi:10.1161/hypertensionaha.116.07862

Cited by 196 publications

(125 citation statements)

References 12 publications

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“…10 The study highlights the need to determine which antihypertensive agent(s) provides optimal control of chronic hypertension in pregnancy to ameliorate these risks.…”

Section: Hypertensionmentioning

confidence: 99%

“…10 The study highlights the need to determine which antihypertensive agent(s) provides optimal control of chronic hypertension in pregnancy to ameliorate these risks.Choice of antihypertensive outside pregnancy depends on ethnicity with those of African/Caribbean family origin receiving calcium channel blockers as first-line agent 11 and is thought to relate to differences in the pathophysiology causing hypertension in those of differing ethnic backgrounds. …”

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confidence: 99%

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Labetalol Versus Nifedipine as Antihypertensive Treatment for Chronic Hypertension in Pregnancy

et al. 2017

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maternal morbidity in these women (post hoc analysis). 10 The study highlights the need to determine which antihypertensive agent(s) provides optimal control of chronic hypertension in pregnancy to ameliorate these risks.Choice of antihypertensive outside pregnancy depends on ethnicity with those of African/Caribbean family origin receiving calcium channel blockers as first-line agent 11 and is thought to relate to differences in the pathophysiology causing hypertension in those of differing ethnic backgrounds. 12Ethnic disparity in maternal and perinatal outcome in the general pregnant population is well described and likely to be multifactorial. 13 To our knowledge, no randomized controlled trials have investigated the impact of ethnicity on efficacy of antihypertensive treatment in pregnancy. The aims of the PANDA study (Pregnancy and Chronic Hypertension: Nifedipine Versus Labetalol as Antihypertensive Treatment) were 3-fold: to assess feasibility of such a randomized controlled trial, to evaluate mechanistic treatment effects, and to examine the impact of ethnicity on efficacy of nifedipine (a calcium channel blocker with a well-established safety profile in pregnancy) with labetalol (currently recommended as firstline by national UK guidance). MethodsThe study was an open-label, phase 4, randomized controlled clinical trial (EudraCT Number 2013-003144-23 +6 weeks (to allow for second trimester BP nadir), singleton pregnancies, aged >18 years, and the ability to provide written informed consent. Women were excluded if they had a contraindication (relative or absolute) to either antihypertensive agent, such as labetalol in women with asthma. Details of the randomization process, intervention, and outcome measures are contained in the online-only Data Supplement. Statistical AnalysisFor the primary analysis, the intention to treat principle was applied; women were analyzed in the groups into which they were randomly allocated regardless of allocation received. The statistical software Stata/SE version 14 for Windows was used for all analyses. The number and percentage were calculated for binary and categorical variables. The mean and SD or the median and interquartile range were calculated for continuous variables. Linear regression with robust SE was used for the primary and other continuous outcomes. Adjustment was made for baseline covariates, including ethnicity (black [determined by self-report of whether the woman had a parent or grandparent who was African or Caribbean] versus non-black [all other ethnicities]), gestational age at randomization, and center. For continuous measures, an adjustment was also made for corresponding baseline measurement (systolic BP at randomization for the primary clinical outcome). For binary outcomes, binary regression with a log link was used to calculate risk ratios (RR). Analysis of the primary clinical outcomes was repeated excluding women delivering their baby before 24 completed weeks of pregnancy because women who deliver before viability did not complete the inten...

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“…10 The study highlights the need to determine which antihypertensive agent(s) provides optimal control of chronic hypertension in pregnancy to ameliorate these risks.…”

Section: Hypertensionmentioning

confidence: 99%

mentioning

confidence: 99%

Labetalol Versus Nifedipine as Antihypertensive Treatment for Chronic Hypertension in Pregnancy

et al. 2017

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“…Although there has previously been debate about the optimal blood pressure treatment threshold and the ideal blood pressure treatment target in pregnancy (primarily due to concerns that low blood pressure might be associated with fetal growth restriction),4,7 there is growing evidence that severe hypertension (≥160/110 mm Hg) is associated with a further increase in adverse maternal and perinatal outcomes (compared with those with hypertension who do not develop severe hypertension) 8. More recently, the Control of Hypertension In Pregnancy Study (CHIPS) has highlighted the maternal benefit of ‘tight’ (diastolic target 85 mm Hg) compared with ‘less tight’ control (diastolic target 100 mm Hg) on reducing the maternal risk of severe hypertension without an increase in perinatal adverse outcomes 9.…”

Section: Why Is the Management Of Hypertension In Pregnancy Important?mentioning

confidence: 99%

What is the evidence for using labetalol as a first-line treatment option for hypertension in pregnancy?

Webster

Webb

Chappell

2018

DTB

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“…Pregnancy induced hypertension, preeclampsia and complications occur at gestational age more than 20 weeks with maternal blood pressure at ≥ 140 / 90mmHg ( American College of Obstetricians and Gynecologists, 2013;Kattach & Garovic, 2014;Melamed et al, 2014;Magee et al, 2016;Zhang et al, 2017). Preeclampsia and eclampsia contribute to maternal death for every 3 minutes worldwide (Mammaro et al, 2009;Meshram et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Type of Delivery and Length of Stay in Hypertension Patients

Syahriana¹,

Mappaware²,

Hasibuan³

et al. 2018

GJHS

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Introduction: The length of stay (LOS) for pregnant mothers with vaginal delivery is different from that of caesarean delivery. Hypertension during pregnancy may be an indication to conduct caesarean delivery that affects length of stay in hospitals. Material and Methods:The total collected samples were 108 pregnant mothers and they were divided into 2 groups, 54 pregnant mothers with normal blood pressure and 54 pregnant mothers with hypertension. Maternal characteristics, routine hematology, blood pressure (BP) status, type of delivery and length of stay were analyzed.Results: Type of delivery, maternal age, height, weight, body mass index (BMI), systolic blood pressure, diastolic blood pressure, length of stay, and routine hematologic profile except leukocytes showed statistically significant correlations with hypertension for the total 108 pregnant mothers. Pregnant mothers with caesarean delivery due to pregnancy induced hypertension (PIH) was threefold than those of normal blood pressure (95% confidence interval, 1.343-6.563). Statistical analyses indicated significant correlations between type of delivery and length of stay for pregnant mothers with hypertension after delivery (p-value = 0.000). Conclusion:On average, pregnant mothers who had hypertension with caesarean delivery spent at least 49-72 hours in the hospital after delivery. Indeed, the Royal College of Obstetricians and Gynecologists recommended that pregnant mothers with vaginal delivery should stay in a hospital for 1 or 2 days and those with caesarean section were suggested to stay 3 or 4 days after delivery. However, some pregnant mothers in this study spent shorter time to stay at the hospital after delivery. Therefore, it is suggested for pregnant mothers to stay at a hospital in a more sufficient period of time after delivery to give an adequate time for physicians to classify, to diagnose, or to treat complications after delivery.

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The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study)

Abstract: Supplemental Digital Content is available in the text.

Cited by 196 publications

References 12 publications

Labetalol Versus Nifedipine as Antihypertensive Treatment for Chronic Hypertension in Pregnancy

Labetalol Versus Nifedipine as Antihypertensive Treatment for Chronic Hypertension in Pregnancy

What is the evidence for using labetalol as a first-line treatment option for hypertension in pregnancy?

Type of Delivery and Length of Stay in Hypertension Patients

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