Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Lower systolic blood pressure levels in early pregnancy are associated with a decreased risk of early-onset superimposed preeclampsia in women with chronic hypertension: a multicenter retrospective study

Hypertension Research volume 45, pages 135–145 (2022)Cite this article

Abstract

To clarify the impact of blood pressure (BP) management ranges on pregnancy outcomes, we conducted a multicenter retrospective analysis of 215 women with singleton pregnancies diagnosed with essential hypertension either before or within 14 weeks of gestation. Patients were classified according to systolic BP (sBP; <130, 130–139, 140–159, and ≥160 mmHg) or diastolic BP (dBP; <80, 80–89, 90–109, and ≥110 mmHg) at 8–11, 12–15, and 16–19 weeks of gestation. The risk of early-onset superimposed preeclampsia and small-for-gestational-age neonates was assessed in each BP group. Moreover, a subgroup analysis was performed in 144 eligible patients whose BP was measured at both 12–13 and 14–15 weeks of gestation. At 16–19 weeks of gestation, higher sBP significantly increased the incidence of early-onset superimposed preeclampsia (13.3%, 24.6%, 32.2% and 75.0%, respectively) and small-for-gestational-age neonates (6.0%, 13.1%, 16.9% and 50.0%, respectively). Multivariate logistic regression analyses showed that women with sBP < 130 mmHg at 16–19 weeks of gestation had a significantly lower risk of early-onset superimposed preeclampsia than women with sBP of 140–159 mmHg. Subgroup analyses also showed that even at 14–15 weeks of gestation, sBP < 130 mmHg was associated with a significantly lower risk of early-onset superimposed preeclampsia than an sBP of 140–159 mmHg. In conclusion, sBP < 130 mmHg within 14 weeks of gestation reduced the risk of developing early-onset superimposed preeclampsia in women with chronic hypertension.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension. 2018;72:24–43.

    Article  CAS  Google Scholar 

  2. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 203: Chronic hypertension in pregnancy. Obstet Gynecol. 2019;133:e26–e50.

    Article  Google Scholar 

  3. Magee LA, Khalil A, Kametas N, Von Dadelszen P. Toward personalized management of chronic hypertension in pregnancy. Am J Obstet Gynecol. 2020;S0002-9378:30745–6.

    Google Scholar 

  4. National Institute for Health and Care Excellence. Hypertension on pregnancy: diagnosis and management. 2019. https://www.nice.org.uk/guidance/ng133.

  5. Bramham K, Parnell B, Nelson-Piercy C, Seed PT, Poston L, Chappell LC. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ. 2014;348:g2301.

    Article  Google Scholar 

  6. Panaitescu AM, Syngelaki A, Prodan N, Akolekar R, Nicolaides KH. Chronic hypertension and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol. 2017;50:228–35.

    Article  CAS  Google Scholar 

  7. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:1269–324.

    Article  CAS  Google Scholar 

  8. Ueda A, Nakakita B, Chigusa Y, Mogami H, Inohaya A, Yamaguchi K, et al. Tight systolic blood pressure control early in pregnancy improves pregnancy outcomes in women with chronic hypertension. Hypertens Res Pregnancy. 2019;7:75–81.

    Article  Google Scholar 

  9. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation. 2005;111:697–716.

    Article  Google Scholar 

  10. Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: clinical issues and management. A Review. BMC Pregnancy Childbirth. 2009;9:8.

    Article  Google Scholar 

  11. Marsal K, Persson PH, Larsen T, Lilja H, Selbing A, Sultan B. Intrauterine growth curves based on ultrasonically estimated foetal weights. Acta Paediatr. 1996;85:843–8.

    Article  CAS  Google Scholar 

  12. Itabashi K, Miura F, Uehara R, Nakamura Y. New Japanese neonatal anthropometric charts for gestational age at birth. Pediatr Int. 2014;56:702–8.

    Article  Google Scholar 

  13. Nzelu D, Dumitrascu-Biris D, Nicolaides KH, Kametas NA. Chronic hypertension: first-trimester blood pressure control and likelihood of severe hypertension, preeclampsia, and small for gestational age. Am J Obstet Gynecol. 2018;218:337.e1–337.e7.

    Article  Google Scholar 

  14. Burton GJ, Woods AW, Jauniaux E, Kingdom JCP. Rheological and physiological consequences of conversion of the maternal spiral arteries for uteroplacental blood flow during human pregnancy. Placenta. 2009;30:473–82.

    Article  CAS  Google Scholar 

  15. Burton GJ, Jauniaux E. Pathophysiology of placental-derived fetal growth restriction. Am J Obstet Gynecol. 2018;218:S745–S761.

    Article  CAS  Google Scholar 

  16. Magee LA, von Dadelszen P, Rey E, Ross S, Asztalos E, Murphy KE, et al. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med. 2015;372:407–17.

    Article  CAS  Google Scholar 

  17. Macdonald-Wallis C, Silverwood RJ, Fraser A, Nelson SM, Tilling K, Lawlor DA, et al. Gestational-age-specific reference ranges for blood pressure in pregnancy: findings from a prospective cohort. J Hypertens. 2015;33:96–105.

    Article  CAS  Google Scholar 

  18. Battarbee AN, Sinkey RG, Harper LM, Oparil S, Tita ATN. Chronic hypertension in pregnancy. Am J Obstet Gynecol. 2020;222:532–41.

    Article  Google Scholar 

Download references

Acknowledgements

The facilities participating in this study were as follows: Kyoto University Hospital, Kurashiki Central Hospital, Kindai University Hospital, Hyogo Prefectural Amagasaki General Medical Center, Shizuoka General Hospital, National Hospital Organization Kyoto Medical Center, Kobe City Medical Center General Hospital, Japanese Red Cross Wakayama Medical Center, National Hospital Organization Osaka National Hospital, Kitano Hospital, Japanese Red Cross Otsu Hospital, Mitsubishi Kyoto Hospital, Takamatsu Red Cross Hospital, Japan Baptist Hospital and Rakuwakai Otowa Hospital.

We would like to thank Tetsuro HONDA, Takashi NAKAHORI, Ken FUKUHARA, Tomoyuki KUSUMOTO, Hikaru KIYOKAWA, Masahiro KUROIWA, Akihiro SHOJI, Yu TANAKA, Tomoki NISHIMURA, Rie HARA, Kazushi KOJIMA, Ryosuke KURODA, Shihori NAKAMURA and Hiroyuki TERABAYASHI at Kurashiki Central Hospital; Kosuke MURAKAMI and Yoshie YO at Kindai University Hospital; Masaya HIROSE at Hyogo Prefectural Amagasaki General Medical Center; Hirohiko TANI, Naoki HORIKAWA, Rei GO, Yoshihide INAYAMA, Maki UMEMIYA, Ryosuke KURODA, Sae YU, Suguru FUJITSUKA and Teruki YOSHIDA at Shizuoka General Hospital; Ikuko EMOTO and Koichi WATANABE at National Hospital Organization Kyoto Medical Center; Saeko TANABE and Ayami KOIKE at Kobe City Medical Center General Hospital; Mayo HINO at Japanese Red Cross Wakayama Medical Center; Yuichiro KOSHIDA at National Hospital Organization Osaka National Hospital; Atsuko TAGA and Kohei HAMADA at Kitano Hospital; Takanao ONJI and Ryoko OTANI at Japanese Red Cross Otsu Hospital; Koji SEO at Rakuwakai Otowa Hospital; Mariko FUJIMOTO and Hironao KOBAYASHI at Mitsubishi Kyoto Hospital; Ayaka NAKAMURA, Masumi YANAGAWA, Yukiko MIKAMI, and Hanako TAMAI at Japan Baptist Hospital; and Baku NAKAKITA at Kyoto University for management of cohort data in this manuscript. This study was performed under the research grant from the Japan Society for the Study of Hypertension in Pregnancy.

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan

    Akihiko Ueda, Yoshitsugu Chigusa, Haruta Mogami, Masaki Mandai & Eiji Kondoh

  2. Department of Obstetrics and Gynecology, Kurashiki Central Hospital, Okayama, Japan

    Masaaki Hasegawa

  3. Department of Obstetrics and Gynecology, Kindai University Hospital, Osaka, Japan

    Noriomi Matsumura

  4. Department of Obstetrics and Gynecology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan

    Hiroshi Sato

  5. Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka, Japan

    Kenzo Kosaka

  6. Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    Kaoru Abiko

  7. Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Hyogo, Japan

    Shinya Yoshioka

  8. Department of Obstetrics and Gynecology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan

    Takaaki Yoshida

  9. Department of Obstetrics and Gynecology, National Hospital Organization Osaka National Hospital, Osaka, Japan

    Keiji Tatsumi

  10. Department of Obstetrics and Gynecology, Kitano Hospital, Osaka, Japan

    Toshihiro Higuchi

  11. Department of Obstetrics and Gynecology, Japanese Red Cross Otsu Hospital, Shiga, Japan

    Kohei Fujita

  12. Department of Obstetrics and Gynecology, Mitsubishi Kyoto Hospital, Kyoto, Japan

    Shoko Sasaki

  13. Department of Obstetrics and Gynecology, Takamatsu Red Cross Hospital, Kagawa, Japan

    Masaki Goto

  14. Department of Obstetrics and Gynecology, Japan Baptist Hospital, Kyoto, Japan

    Hiroshi Takai

  15. Department of Obstetrics and Gynecology, Rakuwakai Otowa Hospital, Kyoto, Japan

    Norimasa Sagawa

Authors
  1. Akihiko Ueda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masaaki Hasegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Noriomi Matsumura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroshi Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kenzo Kosaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kaoru Abiko
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shinya Yoshioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takaaki Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Keiji Tatsumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Toshihiro Higuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kohei Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Shoko Sasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Masaki Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Hiroshi Takai
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Yoshitsugu Chigusa
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Haruta Mogami
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Norimasa Sagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Masaki Mandai
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Eiji Kondoh
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the KAMOGAWA study group

Corresponding author

Correspondence to Eiji Kondoh.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Members of the Kyoto Academy Members of Obstetrics and Gynecology Aiming for Women’s Aid (KAMOGAWA) study are listed in the Acknowledgment section.

Supplementary Infromation

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ueda, A., Hasegawa, M., Matsumura, N. et al. Lower systolic blood pressure levels in early pregnancy are associated with a decreased risk of early-onset superimposed preeclampsia in women with chronic hypertension: a multicenter retrospective study. Hypertens Res 45, 135–145 (2022). https://doi.org/10.1038/s41440-021-00763-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41440-021-00763-6

Keywords

This article is cited by

Search

Advanced search

Quick links