From: Evidence review for interventions for chronic hypertension
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National Guideline Alliance (UK). Evidence review for interventions for chronic hypertension: Hypertension in pregnancy: diagnosis and management: Evidence review A. London: National Institute for Health and Care Excellence (NICE); 2019 Jun. (NICE Guideline, No. 133.)
Evidence review for interventions for chronic hypertension: Hypertension in pregnancy: diagnosis and management: Evidence review A.
Show detailsTable 2Summary of the included studies
Study | Participants/Diagnosis (and definition) | Intervention | Control | Outcomes |
---|---|---|---|---|
Multicentre Individual participant data meta-analysis |
N=3303 women with chronic hypertension No definition provided |
Antiplatelet: predominantly aspirin (27 of the included studies), given in doses ranging from 50 to 150mg per day. 59% of women commenced treatment before 20 weeks’ gestation. 3 trials used aspirin with dipyridamole and 3 used different antiplatelet agents | No intervention: either placebo or no treatment |
|
Atallah 1996 (ECPPA) Brazil RCT |
N=473 women with chronic hypertension No definition provided | Aspirin: 60mg PO daily from 12 weeks’ gestation (or immediately following randomisation, if this was after 12 weeks) until delivery | No intervention: placebo tablets daily from 12 weeks’ gestation (or immediately following randomisation, if this was after 12 weeks) until delivery | |
UK RCT |
N=29 women with chronic hypertension sBP between 140 and 170mmHg and dBP between 90 and 110mmHg on 2 occasions separated by at least 24 hours | Atenolol: 50mg PO daily up to 200mg | No intervention: placebo tablets |
|
Egypt and Saudi Arabia RCT |
N=76 women with chronic hypertension sBP between 140 and 160mmHg and dBP between 90 and 110mmHg at least 6 hours apart in the first half of pregnancy | Induction of labour | Expectant management |
|
Brazil RCT |
N=116 women with CHT (90.5%) or previous PE (9.5%) BP ≥ 140/90mmHg diagnosed before pregnancy or before 20 weeks’ gestation | Exercise (30 minutes per week riding a stationary bike) | No intervention |
|
South America, North America, Israel, Jordan, Oceania and Europe RCT |
N=981 women with CHT (75.02%) or GH (24.98%) dBP ≥90mmHg before pregnancy or before 20+0 weeks’ gestation | Less-tight control (aiming for a target of dBP of 100mmHg) | Tight control (aiming for a target of dBP of 85mmHg) |
|
UK RCT |
N=72 women with CHT (65.2%) or PE (34.8%) BP ≥110/170mmHg on two separate occasions before 20 weeks’ gestational age | Labetalol: 100mg × 4 times/day | Methyldopa: 250 mg × 4 times/day |
|
USA RCT |
N=186 women with chronic hypertension Defined as use of antihypertensive agent at baseline, or resting BP ≥ 140/90mmHg on two occasions at least four hours apart prior to pregnancy, or before 20 weeks’ gestation | Aspirin: 60mg PO once daily, started prior to 17 weeks’ gestation | No intervention: placebo tablets started prior to 17 weeks’ gestation | |
Italy RCT |
N=240 women with chronic hypertension or nephropathy Defined as diastolic BP 90 to 100mmHg or nephropathy with normal renal function and normal BP | Aspirin: 50mg PO once daily from randomisation (at 16 to 32 weeks) until delivery | No intervention |
|
Multicentre (UK, Spain, Italy, Belgium, Greece and Israel) RCT |
N=110 women with chronic hypertension Study participants self-reported a diagnosis of chronic hypertension at the 11-13 week visit | Aspirin: 150mg PO once daily from randomisation (approximately 12-13 weeks) until 36 weeks’ gestation | No intervention: placebo tablet to be taken once daily from randomisation until 36 weeks’ gestation |
|
UK RCT |
N=208 women with CHT sBP >140 or dBP>90 on 2 occasions at least 24 hours apart before 28 weeks’ GA | Methyldopa: dose and administration route not reported | No intervention |
|
USA RCT |
N=263 women with CHT Definition was not reported |
Methyldopa: 750 mg/day up to 4g/day Labetalol: 300 mg/day increased up to 2400 mg/day. | No intervention |
|
Multicentre Individual participant data meta-analysis |
N=2518 women with chronic hypertension No definition provided |
Antiplatelet: predominantly aspirin (15 of the included studies), given in doses ranging from 60 to 150mg per day. 1 trial used aspirin with dipyridamole and 1 used dipyridamole alone. | No intervention: either placebo or no treatment |
|
Panama RCT |
N=39 women with CHT BP >140/90 mmHg present before pregnancy or for first time before the 20th week of gestation | Amlodipine: 5mg/day PO | Aspirin: 75mg/day PO |
|
Finland RCT |
N=208 women with chronic hypertension (89%) or severe pre-eclampsia in a previous pregnancy CHT defined as BP >140/90mmHg without treatment prior to pregnancy | Aspirin: 50mg aspirin/day PO | No intervention: placebo tablets to be taken daily PO |
|
UK RCT |
N=114 women with CHT BP ≥140/90mmHg before 20 weeks’ gestation requiring antihypertensive treatment before 27+ 6 weeks’ | Labetalol: 100 mg BID up to 1800 mg | Nifedipine: 10 mg BID up to 80 mg |
|
US RCT |
N=25 women with CHT BP ≥140/90 mmHg on 2 separate occasions at least 6 hours apart | Methyldopa: 250 mg PO TID | No intervention: one placebo tablet PO TID |
|
BID: twice a day; BP: blood pressure; CHT: chronic hypertension; dBP: diastolic blood pressure; GA: gestational age; GH: gestational hypertension; HELLP: haemolysis, elevated liver enzymes and low platelet count; mmHg: millimetres of mercury; N: total number of participants; PE: pre-eclampsia; PO: orally; sBP: systolic blood pressure; TID: three times a day
- a
Data are included in individual participant data meta-analyses (by Askie 2007 or van Vliet 2017) therefore not analysed separately
- b
Participants in this report are also included in the IPD by Askie 2007
- Table 2, Summary of the included studies - Evidence review for interventions for...Table 2, Summary of the included studies - Evidence review for interventions for chronic hypertension
- tyrosine-protein phosphatase non-receptor type 12 isoform 3 [Homo sapiens]tyrosine-protein phosphatase non-receptor type 12 isoform 3 [Homo sapiens]gi|196114970|ref|NP_001124481.1|Protein
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