Impact of Antihypertensive Treatment on Maternal and Perinatal Outcomes in Pregnancy Complicated by Chronic Hypertension: A Systematic Review and Meta‐Analysis
Open Access
- 5 May 2017
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American Heart Association
- Vol. 6 (5), e005526
- https://doi.org/10.1161/jaha.117.005526
Abstract
Background: Chronic hypertension complicates around 3% of all pregnancies. There is evidence that treating severe hypertension reduces maternal morbidity. This study aimed to systematically review randomized controlled trials of antihypertensive agents treating chronic hypertension in pregnancy to determine the effect of this intervention.Methods and Results: Medline (viaOVID), Embase (viaOVID) and the Cochrane Trials Register were searched from their earliest entries until November 30, 2016. All randomized controlled trials evaluating antihypertensive treatments for chronic hypertension in pregnancy were included. Data were extracted and analyzed in Stata (version 14.1). Fifteen randomized controlled trials (1166 women) were identified for meta‐analysis. A clinically important reduction in the incidence of severe hypertension was seen with antihypertensive treatment versus no antihypertensive treatment/placebo (5 studies, 446 women; risk ratio 0.33, 95%CI0.19‐0.56; I20.0%). There was no difference in the incidence of superimposed pre‐eclampsia (7 studies, 727 women; risk ratio 0.74, 95%CI0.49‐1.11; I228.1%), stillbirth/neonatal death (4 studies, 667 women; risk ratio 0.37, 95%CI0.11‐1.26; I20.0%), birth weight (7 studies, 802 women; weighted mean difference −60 g, 95%CI−200 to 80 g; I20.0%), or small for gestational age (4 studies, 369 women; risk ratio 1.01, 95%CI0.53‐1.94; I20.0%) with antihypertensive treatment versus no treatment/placebo.Conclusions: Antihypertensive treatment reduces the risk of severe hypertension in pregnant women with chronic hypertension. A considerable paucity of data exists to guide choice of antihypertensive agent. Adequately powered head‐to‐head randomized controlled trials of commonly used antihypertensive agents are required to inform prescribing.This publication has 78 references indexed in Scilit:
- Antenatal magnesium sulphate may prevent cerebral palsy in preterm infants-but are we convinced? Evaluation of an apparently conclusive meta-analysis with trial sequential analysisBJOG: An International Journal of Obstetrics and Gynaecology, 2010
- Adverse Perinatal Outcomes and Risk Factors for Preeclampsia in Women With Chronic HypertensionHypertension, 2008
- The Accuracy of Reporting of the Hypertensive Disorders of Pregnancy in Population Health DataHypertension in Pregnancy, 2008
- Blood Pressure in Adulthood and Life Expectancy With Cardiovascular Disease in Men and WomenHypertension, 2005
- Measuring inconsistency in meta-analysesBMJ, 2003
- Oral beta-blockers for mild to moderate hypertension during pregnancyEmergencias, 2003
- The haemodynamic effects of ketanserin versus dihydralazine in severe early-onset hypertension in pregnancyBJOG: An International Journal of Obstetrics and Gynaecology, 1998
- Treatment of hypertension in pregnancy with methyldopa: A randomized double blind studyInternational Journal of Gynecology & Obstetrics, 1987
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986
- Randomised comparison of methyldopa and oxprenolol for treatment of hypertension in pregnancy.BMJ, 1979