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

Abstract

Currently, there is controversy regarding the treatment of pregnant patients with mild hypertension (blood pressure 140–159/90–109 mm Hg). While guidelines do not recommend this treatment, results from recent clinical trials are supportive of the treatment. This meta‐analysis aimed to clarify if active treatment of mild hypertension during pregnancy results in better maternal and fetal outcomes. All of the potentially eligible randomized controlled trials were retrieved through a systematic database search investigating the impact of pharmacological treatment in mild hypertensive patients on maternal, fetal, and neonatal outcomes. Relative risk (RR) and 95% confidence interval (CI) were calculated using a random‐effects model. Data from 12 trials comprising 4461 pregnant women diagnosed with mild to moderate hypertension (2395 in the intervention group and 2066 in the control group) were extracted for quantitative synthesis. Antihypertensive treatment was associated with better outcomes in seven out of the 19 analyzed outcomes: 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]). The primary safety outcome of small for gestational age was not different between the treatment group and the control group (RR = 1.12; 95% CI = [0.80; 1.57]). The results of this meta‐analysis are in favor of the beneficial impact of pharmacological treatment of mild hypertension on both maternal and neonatal outcomes and without significant adverse events for the fetus.

The association between blood pressure control in women during pregnancy and adverse perinatal outcomes: the TMM BirThree Cohort Study

“…More recently, Tita et al reported that active treatment of pregnant women for mild hypertension (<160/100 mmHg), achieving a BP of <140/90 mmHg, did not increase the prevalence of SGA among their offspring compared to that of the offspring of pregnant women not receiving such treatment [ 16 ]. There is an update meta-analysis of randomized controlled trial that antihypertensive treatment was associated with better outcomes in maternal complications and neonatal mortality for pregnant women with mild hypertension (140–159/90–109 mmHg), without increased a chance of SGA [ 17 ]. Our results that the risk of adverse perinatal outcomes was high in uncontrolled BP might support those findings that BP during pregnancy should be controlled to <140/90 mmHg.…”

Treatment of hypertension during pregnancy: a cohort of pregnancy episodes from the SIDIAP database, Catalonia, Spain

“…Our results showed higher use of antihypertensives in the first trimester among pregnancies with chronic hypertension, in agreement with the guidelines; however, to date, there is no consensus on the BP values to start antihypertensive medication for pregnancies with BP < 160/90 mmHg. Two recently published meta-analyses have shown better outcomes for pregnancies receiving antihypertensive medications, and a network meta-analysis showed that even if all antihypertensives reduce the risk of severe hypertension, labetalol may also decrease proteinuria/preeclampsia and fetal/newborn death ( Bone et al, 2022 ; Attar et al, 2023 ). The boundaries for BP values for when to start medication are uncertain, making this area suitable for shared decision making (SDM), with some research focusing in developing tools for SDM in women with moderate hypertension ( Whybrow et al, 2022 ).…”

Table1.pdf

“…Frontiers in Pharmacology frontiersin.org may also decrease proteinuria/preeclampsia and fetal/newborn death (Bone et al, 2022;Attar et al, 2023). The boundaries for BP values for when to start medication are uncertain, making this area suitable for shared decision making (SDM), with some research focusing in developing tools for SDM in women with moderate hypertension (Whybrow et al, 2022).…”