CHAP
Chronic Hypertension and Pregnancy trial
Doente / População Intervenção / Exposição Comparação Desfecho
In 2,408 pregnant women with mild chronic hypertension, antihypertensive treatment targeting a blood pressure below 140/90 mmHg reduced severe pre-eclampsia, medically indicated preterm birth, placental abruption or fetal or neonatal death compared with treatment withheld unless blood pressure reached 160/105 mmHg.
N
2408
Desenho
Open-label RCT
Desfecho
Composite of pre-eclampsia with severe features, indicated preterm birth before 35 weeks, placental abruption, or fetal or neonatal death
Relevância
1
Resultado30.2 % vs 37.0 % (adjusted RR 0.82; 95 % CI 0.74–0.92; p<0.001), with no increase in small-for-gestational-age birth weight (11.2 % vs 10.4 %).
Tita AT, Szychowski JM, Boggess K, et al. N Engl J Med. 2022;386(19):1781-1792. 10.1056/NEJMoa2201295
Discussão e crítica
Open-label with a partly clinician-adjudicated composite, and the benefit is driven by pre-eclampsia rather than hard neonatal outcomes. But it answered the fetal-growth question that had paralysed practice for decades — treating to below 140/90 mmHg does not cause growth-restricted babies — and shifted mild chronic hypertension from permissive to active treatment.