• About Us
    • Contact Us
    • Login
    • ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
About Us Contact Us Login ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
Grand Rounds

The Latest ACC/ AHA BP Category Guidelines and Risk of Hypertensive Disorders of Pregnancy

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • The ACC/ AHA blood pressure guidelines, revised in November 2017, redefine BP categories
    • Stage 1: systolic 130-139mmHg or diastolic 80-89mmHg
    • Elevated: systolic 120-129mmHg and diastolic <80mmHg
    • Normal: <120/<80 mmHg
  • Relevance to obstetric population is currently unknown
  • Hausburg et al. (AJOG, 2019) evaluated the risk of gestational hypertension or preeclampsia based on BP category and trajectory

METHODS:

  • Prospective observational cohort study
  • Data set
    • Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b)
    • Nulliparous | Singleton pregnancies | No history of pre-pregnancy hypertension (≥140/90 mmHg) or diabetes
  • Compared
    • Frequency of hypertensive disorders of pregnancy using ACC/AHA BP category at a first trimester study visit
    • BP trajectory between study visits in the first and second trimesters
  • BP trajectories were categorized based on difference between visit 1 and 2 as
    • Stable: <5mmHg difference
    • Upward : ≥5mmHg
    • Downward: ≤-5mmHg
  • Data analysis: Associations of BP category and trajectory with
    • Preeclampsia and gestational hypertension
    • Univariate analysis and multinomial logistic regression analysis with co-variates identified a priori to account for confounding

RESULTS:

  • 8,899 women were included in the analysis
  • Mean gestational age at study visit
    • Study visit 1: 11.6 weeks
    • Study visit 2: 19.0 weeks
  • Increasing blood pressure category was associated with a higher risk of all hypertensive disorders
    • Elevated blood pressure: Adusted relative risk (aRR) 1.54 (95%CI, 1.18 to 2.02)
    • Stage 1 hypertension: aRR 2.16 (95%CI, 1.31 to 3.57)
  • Stage 1 hypertension was associated with the highest risk of preeclampsia with severe features: aRR 2.48 (95%CI, 1.38-8.74)
  • Systolic and diastolic blood pressure trajectories were both significantly associated with the risk of hypertensive disorders independent of blood pressure category (p<0.001)
  • Initial BP normal but upward systolic trajectory compared to patients with downward trajectory
    • Risk of any hypertensive disorder: aRR 1.41 (95%CI 1.20-1.65)

CONCLUSION:

  • New BP category system was significantly associated with both preeclampsia and gestational hypertension
    • Category 1 hypertension in the first trimester was associated with double the risk for hypertensive disorders in pregnancy
  • BP trajectory in early pregnancy was independently associated with risk of preeclampsia and gestational hypertension
    • Initial normal BP but upward systolic trajectory compared to patients with downward trajectory was associated with increased risk of 41% of any hypertensive disorder
  • The authors conclude that the new BP guidelines with lower thresholds may identify more women at risk for preeclampsia and gestational hypertension and that more research is needed to determine value of interventions such as low dose aspirin
  • Note: This study was done on data derived from nulliparous population

Learn More – Primary Sources:

Blood pressure trajectory and category and risk of hypertensive disorders of pregnancy in nulliparous women

Want to be notified when new guidelines are released? Get ObGFirst!

Learn More »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

ACC/AHA Blood Pressure Guideline: Current Classification System and Treatment Targets
Does Hypertension in Pregnancy Predict Hypertension Later in Life?
What is the Optimal Blood Pressure Target When Treating Hypertension?
Deliver Low Risk Patients at 39 Weeks to Prevent Hypertensive Complications?

Sections

  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • COVID-19

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site