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Hypertension

Poster Session 4

(1138) Prediction of Pregnancy Outcomes by Various Blood Pressure Metrics among Patients with Mild Chronic Hypertension

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Ayodeji Sanusi, MD, MPH

    Assistant Professor
    Center for Women's Reproductive Health, University of Alabama at Birmingham
    Birmingham, AL, United States

Objective: To assess the ability of various blood pressure (BP) measures to predict adverse pregnancy outcomes in patients with mild chronic hypertension (CHTN).

Study Design: Secondary analysis of an open label RCT of antihypertensive treatment (vs. none) in pregnant patients with mild CHTN (BPs < 160/105 mmHg) and singleton pregnancies < 23 weeks’ gestation. All enrolled patients with ascertained outcomes were included. The primary exposures were average mean arterial pressure (MAP) compared to mean systolic (SBP) and mean diastolic (DBP) blood pressures in pregnancy. The primary outcome was a composite of severe preeclampsia, preterm birth < 35weeks, placental abruption, and fetal or neonatal death. Receiver operating curves (including c-statistics and 95% CI) from adjusted multivariable logistic regression models were used to compare predictive ability of the various BP measures with respect to adverse outcomes.

Results: Participants were included if they had at least 1 prenatal blood pressure measurement and the primary composite (N=2,267).  Mean age was 32.3 ± 5.6 years, 1075 (47.4%) were Black and >50% had public insurance. Over half (n=1,233, 54.4%) were on anti-HTN medications at baseline and >80% were multiparous. Average mean MAP, SBP and DBP in pregnancy were 97.2 ± 7.6, 130.7 ± 10.1, and 80.5 ± 7.7mmHg respectively. All BP measures were modest predictors of the primary outcome, however, MAP was a significantly better predictor of the primary outcome compared to SBP and DBP (mean difference: MAP vs. SBP 0.02, 95% 0.01-0.04; MAP vs. DBP 0.02, 95% CI 0.01-0.03). For all other secondary outcomes except SGA and respiratory support, MAP was marginally better at predicting outcomes. DBP was the best predictor of small for gestational age < 10
th

percentile, while SBP best predicted any neonatal respiratory support.

Conclusion: Compared to SBP and DPB, MAP is a better predictor of most adverse outcomes in pregnant patients with mild chronic hypertension.