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Optimal blood pressure target to prevent severe hypertension in pregnancy: A systematic review and meta-analysis

Hypertension Research volume 45, pages 887–899 (2022)Cite this article

A Comment to this article was published on 25 February 2022

Abstract

Severe hypertension in pregnancy is a hypertensive crisis that requires urgent and intensive care due to its high maternal and fetal mortality. However, there is still a conflict of opinion on the recommendations of antihypertensive therapy. This study aimed to identify the optimal blood pressure (BP) levels to prevent severe hypertension in pregnant women with nonsevere hypertension. Ovid MEDLINE and the Cochrane Library were searched, and only randomized controlled trials (RCTs) were included if they compared the effects of antihypertensive drugs and placebo/no treatment or more intensive and less intensive BP-lowering treatments in nonsevere hypertensive pregnant patients. A random effects model meta-analysis was performed to estimate the pooled risk ratio (RR) for the outcomes. Forty RCTs with 6355 patients were included in the study. BP-lowering treatment significantly prevented severe hypertension (RR, 0.46; 95% CI, 0.37–0.56), preeclampsia (RR, 0.82; 95% CI, 0.69–0.98), severe preeclampsia (RR, 0.38; 95% CI, 0.17–0.84), placental abruption (RR, 0.52; 95% CI, 0.32–0.86), and preterm birth (< 37 weeks; RR, 0.81; 95% CI, 0.71–0.93), while the risk of small for gestational age infants was increased (RR, 1.25; 95% CI, 1.02–1.54). An achieved systolic blood pressure (SBP) of < 130 mmHg reduced the risk of severe hypertension to nearly one-third compared with an SBP of ≥ 140 mmHg, with a significant interaction of the BP levels achieved with BP-lowering therapy. There was no significant interaction between the subtypes of hypertensive disorders of pregnancy and BP-lowering treatment, except for placental abruption. BP-lowering treatment aimed at an SBP < 130 mmHg and accompanied by the careful monitoring of fetal growth might be recommended to prevent severe hypertension.

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Authors and Affiliations

  1. Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan

    Makiko Abe & Hisatomi Arima

  2. Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan

    Yuichi Yoshida & Hirotaka Shibata

  3. Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan

    Ako Fukami

  4. Health Administration Center, University of the Ryukyus, Okinawa, Japan

    Atsushi Sakima

  5. Division of Public Health, Hygiene and Epidemiology, Tohoku Medical and Pharmaceutical University, Sendai, Japan

    Hirohito Metoki

  6. Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan

    Kazuhiro Tada

  7. Division of Maternal Medicine, Center for Maternal-Fetal-Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan

    Asako Mito

  8. Department of Endocrinology and Hypertension, Tokyo Women’s Medical University, Tokyo, Japan

    Satoshi Morimoto

  9. Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan

    Masashi Mukoyama

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Abe, M., Arima, H., Yoshida, Y. et al. Optimal blood pressure target to prevent severe hypertension in pregnancy: A systematic review and meta-analysis. Hypertens Res 45, 887–899 (2022). https://doi.org/10.1038/s41440-022-00853-z

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