Poster Session 4
Category: Hypertension
Poster Session 4
Kristen A. Cagino, MD
Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Cabrina I. Becker, MD
Resident
UT Houston
Houston, Texas, United States
Emily Hyde, MD
Resident
UTSW
Dallas, Texas, United States
Beverly Red, BS
Medical Student
UT Houston
Houston, Texas, United States
Christina Cortes, MD
Resident
University of Texas - Houston
Houston, Texas, United States
Anthony Chartier, MD (he/him/his)
Resident
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Claudia Pedroza, PhD
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Chenyue Huang, PhD
Statistician
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Suneet P. Chauhan, MD
Director of MFM Research
Delaware Center for Maternal-Fetal Medicine of Christiana Care
Newark, Delaware, United States
Hector Mendez-Figueroa, MD
Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Sean C. Blackwell, MBA, MD
Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Baha M. Sibai, MD
Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
There is limited evidence for the optimal systolic blood pressure (SBP) threshold for acute treatment of severe hypertension (HTN) in pregnancy. Although SBP ≥ 160 mmHg is used in pregnancy, guidelines for non-pregnant adults support SBP ≥ 180. We compared outcomes using SBP threshold ≥ 180 mmHg versus the current threshold of ≥ 160.
Study Design:
We performed a Quality Improvement before and after non-inferiority study (NCT05881252) of singletons ≥ 20 weeks’ with SBP ≥ 160 mmHg at a level IV hospital. In the before group (10 months), acute antihypertensives (IV labetalol/hydralazine or rapid-acting oral Procardia) were given for persistent SBP ≥ 160 mmHg (or DBP ≥ 110). In the after group (10 months), oral maintenance antihypertensives (labetalol or long-acting Procardia) were given if persistent SBP between 160-179 mmHg (DBP < 110) and acute antihypertensives for persistent SBP ≥ 180 mmHg (or DBP ≥ 110). We excluded if 1) history of or active seizure, stroke (CVA), congestive heart failure (CHF), pulmonary edema, acute kidney injury (AKI) or myocardial ischemia (MI) 2) HELLP syndrome or platelets < 100 x 109/L or 3) neurologic symptoms. The primary outcome was a composite of CHF/pulmonary edema, CVA, AKI, or MI. Bayesian analysis was performed using a non-inferiority margin of 4%.
Results:
From May 2023 to February 2025, we studied 1003 individuals with severe HTN. There were fewer SBP ≥ 160 mmHg (p < 0.01) and a decrease in acute antihypertensives in the after group (170 per 100 individuals in the before versus 61 per 100 individuals in the after group, p < 0.01). The primary outcome occurred in 2.9% of the before and 2.0% of the after group (0.76 median relative risk, 95% credible interval 0.37-1.55) with a 78% probability of risk reduction in the after group and 100% probability that the risk difference in the after group was < 4%.
Conclusion:
In our study, using a SBP threshold of ≥ 180 mmHg for acute treatment of severe HTN led to a non-inferior rate of maternal outcomes and decreased use of IV/rapid acting oral medication. This has implications in resource utilization and healthcare burden.