- Question
- Does a strategy of antihypertensive treatment targeting a blood pressure below 140/90 mm Hg improve pregnancy outcomes in women with mild chronic hypertension without compromising fetal growth?
- Design
- Multicenter, randomized, open-label trial enrolling 2408 pregnant women.
- Population
- Pregnant women with mild chronic hypertension (blood pressure below 160/100 mm Hg) and a singleton fetus at a gestational age of less than 23 weeks.
- Intervention
- Antihypertensive medication recommended for use in pregnancy, with labetalol or extended-release nifedipine as first line, aiming for a blood pressure below 140/90 mm Hg.
- Control
- No antihypertensive treatment unless severe hypertension developed (systolic ≥160 mm Hg or diastolic ≥105 mm Hg).
- Primary outcome
- Composite of preeclampsia with severe features, medically indicated preterm birth before 35 weeks' gestation, placental abruption, or fetal or neonatal death. The safety outcome was small-for-gestational-age birth weight (below the 10th percentile).
- Results
- A primary-outcome event occurred in 30.2% of the active-treatment group versus 37.0% of the control group (adjusted risk ratio 0.82; 95% CI, 0.74 to 0.92; P<0.001). Small-for-gestational-age birth weight was 11.2% vs. 10.4% (adjusted risk ratio 1.04; 95% CI, 0.82 to 1.31; P = 0.76). Any preeclampsia occurred in 24.4% vs. 31.1% (risk ratio 0.79; 95% CI, 0.69 to 0.89).
- Safety
- There was no increase in the risk of small-for-gestational-age birth weight. Serious maternal complications (2.1% vs. 2.8%) and severe neonatal complications (2.0% vs. 2.6%) did not differ significantly between groups.
- Conclusion
- In pregnant women with mild chronic hypertension, treating to a target below 140/90 mm Hg was associated with better pregnancy outcomes than reserving treatment for severe hypertension, with no increase in small-for-gestational-age birth weight.
- Why it matters
- It provided strong randomized evidence supporting antihypertensive treatment of mild chronic hypertension during pregnancy, a question that had previously been uncertain.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026