Treatment for mild hypertension in pregnancy with different strategies: A systematic review and meta‐analysis

Abstract

Objectives: To synthesize the evidence from randomized controlled trials (RCTs) of antihypertensive treatment for mild pregnancy hypertension. Methods:We searched various databases from inception to June 2022, using keywords including hypertension; pregnancy; therapy; treatment; pregnancy outcomes; maternal outcomes; and perinatal outcomes. Only RCTs of antihypertensive treatment for mild hypertension in pregnancy comparing placebo/no therapy were included. We used Review Manager version 5.3 for statistical analyses.Results: In all, eight studies were eligible, with a total of 4211 participants. Compared with control, the active treatment significantly prevented preeclampsia (OR 0.55; 95%CI, 0.39-0.78), placental abruption (OR 0.39; 95%CI, 0.17-0.91), severe hypertension (OR 0.35; 95%CI, 0.17-0.71), end-organ dysfunction (OR 0.34; 95%CI, 0.19-0.62) and preterm birth (OR 0.69; 95%CI, 0.59-0.82), with no increased risk of small for gestational age (SGA) (OR 1.25; 95%CI, 0.78-2.00), or admission to the NICU (OR 0.83; 95%CI, 0.54-1.28). Subgroup analyses demonstrated that the tight control group did not show an advantage over the less-tight control group in improving pregnancy outcomes. Conclusion:In pregnant women with mild pregnancy-induced hypertension or chronic hypertension, antihypertensive treatment still provided precise benefits of improving pregnancy outcomes without increased risk in fetal outcomes.

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

“…Several studies have tried to show the association between antihypertension and preterm birth. A meta-analysis of eight randomized controlled trials comparing hypertension treatment to control showed protection of preterm birth (OR 0.69; 95% CI, 0.59–0.82) ( Chen et al, 2023 ). In contrast, the meta-analysis of 16 observational studies found a higher OR (2.23, 95% CI 1.96–2.53) for preterm birth for women with chronic hypertension compared to normotensive, a four times greater odds of medically indicated preterm birth (ORadj 4.76, 95% CI 3.55–6.14) but no association between chronic hypertension and spontaneous preterm birth (ORadj 1.44, 95% CI 0.74–2.80) ( Al Khalaf et al, 2021 ).…”

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

“…Recently published meta-analyses 25,26 latter study 26 demonstrated that active treatment or tight control regimen increases the risk of SGA compared to no treatment or lesstight control raising concerns regarding the justification to use antihypertensives. It is noteworthy that, unlike the mentioned study, our results just like similar studies, support the use of antihypertensive medications for mild hypertension since our findings did not show any increased chance of developing SGA in patients taking active treatment.…”

“…Recently published meta‐analyses 25 , 26 have been focusing on the same issue with one of them including the results of only eight randomized studies and another one recruiting broader eligibility criteria by including trials comparing active treatment versus placebo or more versus less intensive active treatment. The results of the latter study 26 demonstrated that active treatment or tight control regimen increases the risk of SGA compared to no treatment or less‐tight control raising concerns regarding the justification to use antihypertensives.…”

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“…Several studies have tried to show the association between antihypertension and preterm birth. A meta-analysis of eight randomized controlled trials comparing hypertension treatment to control showed protection of preterm birth (OR 0.69; 95% CI, 0.59-0.82) (Chen et al, 2023). In contrast, the meta-analysis of 16 observational studies found a higher OR (2.23, 95% CI 1.96-2.53) for preterm birth for women with chronic hypertension compared to normotensive, a four times greater odds of medically Frontiers in Pharmacology frontiersin.org indicated preterm birth (ORadj 4.76, 95% CI 3.55-6.14) but no association between chronic hypertension and spontaneous preterm birth (ORadj 1.44, 95% CI 0.74-2.80) (Al Khalaf et al, 2021).…”