The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure?
The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure?
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DOI：
10.1161/hypertensionaha.116.07862
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发表时间：
2016-11
期刊：
影响因子：
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通讯作者：
CHIPS Study Group*
中科院分区：
文献类型：
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作者：
Magee LA;von Dadelszen P;Singer J;Lee T;Rey E;Ross S;Asztalos E;Murphy KE;Menzies J;Sanchez J;Gafni A;Helewa M;Hutton E;Koren G;Lee SK;Logan AG;Ganzevoort W;Welch R;Thornton JG;Moutquin JM;CHIPS Study Group*
文本中提供了补充数字内容。为了确定国际 CHIPS 试验（妊娠期高血压控制研究）中严重高血压的发生是否会导致临床结果不同，调整“不太严格”（目标舒张压 [dBP] 100 mm Hg）与“严格”控制（目标 dBP 85 mm Hg）的干预措施。在对 987 名患有非严重非蛋白尿性高血压或妊娠期高血压的妇女的 CHIPS 数据进行事后分析中，根据严重高血压的发生情况，使用混合效应逻辑回归来比较以下结果，调整分配组和基线因素的影响：CHIPS 主要结果（围产期丢失或 >48 小时的高水平新生儿护理）和次要结果（严重产妇并发症）、出生体重 <10 个百分位、先兆子痫、<34 或<37周、血小板<100×109/L、肝酶升高且有症状、产妇住院时间≥10天、产妇产后6周前再次入院。 CHIPS 中的 334 名妇女 (34.1%) 出现严重高血压，这与除产妇再入院以外的所有检查结果相关 (P=0.20)：CHIPS 主要结局、出生体重 <10%、先兆子痫、早产、肝酶升高（全部 P<0.001）、血小板 <100×109/L (P=0.006) 和住院时间延长 (P=0.03)。严重高血压与严重孕产妇并发症之间的关联仅在不太严格的控制下可见（P=0.02）。对先兆子痫进行调整 (464, 47.3%) 并没有否定严重高血压与 CHIPS 主要结局 (P<0.001)、出生体重 <10% (P=0.005)、分娩 <37 周 (P<0.001) 或 <34 周 (P<0.001) 或有症状的肝酶升高 (P=0.02) 之间的关系。严重高血压是孕产妇和围产期不良结局的风险标志，与血压控制或先兆子痫并发无关。网址：http://pre-empt.cfri.ca/。唯一标识符：ISRCTN 71416914。URL：https://www.clinicaltrials.gov/。唯一标识符：NCT01192412。
Supplemental Digital Content is available in the text. To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of “less tight” (target diastolic blood pressure [dBP] 100 mm Hg) versus “tight” control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for >48 hours) and secondary outcomes (serious maternal complications), birth weight <10th percentile, preeclampsia, delivery at <34 or <37 weeks, platelets <100×109/L, elevated liver enzymes with symptoms, maternal length of stay ≥10 days, and maternal readmission before 6 weeks postpartum. Three hundred and thirty-four (34.1%) women in CHIPS developed severe hypertension that was associated with all outcomes examined except for maternal readmission (P=0.20): CHIPS primary outcome, birth weight <10th percentile, preeclampsia, preterm delivery, elevated liver enzymes (all P<0.001), platelets <100×109/L (P=0.006), and prolonged hospital stay (P=0.03). The association between severe hypertension and serious maternal complications was seen only in less tight control (P=0.02). Adjustment for preeclampsia (464, 47.3%) did not negate the relationship between severe hypertension and the CHIPS primary outcome (P<0.001), birth weight <10th percentile (P=0.005), delivery at <37 (P<0.001) or <34 weeks (P<0.001), or elevated liver enzymes with symptoms (P=0.02). Severe hypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preeclampsia co-occurrence. URL: http://pre-empt.cfri.ca/. Unique identifier: ISRCTN 71416914. URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01192412.