Less-Tight versus Tight Control of Hypertension in Pregnancy
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BACKGROUND: The effects of less-tight versus tight control of hypertension on pregnancy complications are unclear. METHODS: We performed an open, international, multicenter trial involving women at 14 weeks 0 days to 33 weeks 6 days of gestation who had nonproteinuric preexisting or gestational hypertension, office diastolic blood pressure of 90 to 105 mm Hg (or 85 to 105 mm Hg if the woman was taking antihypertensive medications), and a live fetus. Women were randomly assigned to less-tight control (target diastolic blood pressure, 100 mm Hg) or tight control (target diastolic blood pressure, 85 mm Hg). The composite primary outcome was pregnancy loss or high-level neonatal care for more than 48 hours during the first 28 postnatal days. The secondary outcome was serious maternal complications occurring up to 6 weeks post partum or until hospital discharge, whichever was later. RESULTS: Included in the analysis were 987 women; 74.6% had preexisting hypertension. The primary-outcome rates were similar among 493 women assigned to less-tight control and 488 women assigned to tight control (31.4% and 30.7%, respectively; adjusted odds ratio, 1.02; 95% confidence interval [CI], 0.77 to 1.35), as were the rates of serious maternal complications (3.7% and 2.0%, respectively; adjusted odds ratio, 1.74; 95% CI, 0.79 to 3.84), despite a mean diastolic blood pressure that was higher in the less-tight-control group by 4.6 mm Hg (95% CI, 3.7 to 5.4). Severe hypertension (≥160/110 mm Hg) developed in 40.6% of the women in the less-tight-control group and 27.5% of the women in the tight-control group (P<0.001). CONCLUSIONS: We found no significant between-group differences in the risk of pregnancy loss, high-level neonatal care, or overall maternal complications, although less-tight control was associated with a significantly higher frequency of severe maternal hypertension. (Funded by the Canadian Institutes of Health Research; CHIPS Current Controlled Trials number, ISRCTN71416914; ClinicalTrials.gov number, NCT01192412.).
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Data from the previously published CHIPS supports a target blood pressure goal of 110-135/85 mmHg to reduce the risk of uncontrolled maternal hypertension and minimize impaired fetal growth.
“Data from the previously published Control of Hypertension in Pregnancy Study (CHIPS) supports a target blood pressure goal of 110-135/85 mmHg to reduce the risk of uncontrolled maternal hypertension and minimize impaired fetal growth (125-127).”
From 15. Management of Diabetes in Pregnancy: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [126]
The Study Design and Oversight section specifies a tight-control target of 85 mm Hg diastolic, and the Abstract reports less severe maternal hypertension with tight control. The Outcomes section reports no significant difference in small-for-gestational-age newborns between groups. The paper does not establish a systolic target of 110–135 mm Hg or show that this target minimizes impaired fetal growth (page numbers unavailable in our copy). (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe 2015 CHIPS study excluded pregnancies complicated by preexisting diabetes, and only 6% of participants had GDM at enrollment.
“The 2015 study (126) excluded pregnancies complicated by preexisting diabetes, and only 6% of participants had GDM at enrollment.”
From 15. Management of Diabetes in Pregnancy: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [126]
There was no difference in pregnancy loss, neonatal care, or other neonatal outcomes between the groups with tighter versus less tight control of hypertension.
“There was no difference in pregnancy loss, neonatal care, or other neonatal outcomes between the groups with tighter versus less tight control of hypertension (126).”
From 15. Management of Diabetes in Pregnancy: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [126]
In CHIPS, aiming for a diastolic blood pressure of 85 mmHg during pregnancy was associated with reduced likelihood of developing accelerated maternal hypertension and no demonstrable adverse outcome for infants compared with aiming for a higher diastolic blood pressure.
“In CHIPS, aiming for a diastolic blood pressure of 85 mmHg during pregnancy was associated with reduced likelihood of developing accelerated maternal hypertension and no demonstrable adverse outcome for infants compared with aiming for a higher diastolic blood pressure.”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [53]
In CHIPS, the mean systolic blood pressure achieved in the more intensively treated group was 133.1 ± 0.5 mmHg, and the mean diastolic blood pressure achieved in that group was 85.3 ± 0.3 mmHg.
“The mean systolic blood pressure achieved in the more intensively treated group was 133.1 ± 0.5 mmHg, and the mean diastolic blood pressure achieved in that group was 85.3 ± 0.3 mmHg.”
From 10. Cardiovascular Disease and Risk Management: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [46]
In CHIPS, targeting a diastolic blood pressure of 85 mmHg during pregnancy was associated with reduced likelihood of developing accelerated maternal hypertension and no demonstrable adverse outcome for infants compared with targeting a higher diastolic blood pressure.
“In CHIPS, targeting a diastolic blood pressure of 85 mmHg during pregnancy was associated with reduced likelihood of developing accelerated maternal hypertension and no demonstrable adverse outcome for infants compared with targeting a higher diastolic blood pressure.”
From 10. Cardiovascular Disease and Risk Management: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [46]
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Capítulo 1 - Conceituação, Epidemiologia e Prevenção Primária
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12. Management of Diabetes in Pregnancy
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- Authors
- Magee, L. A., von Dadelszen, P., Rey, E., Ross, S., Asztalos, E., Murphy, K. E., Menzies, J., Sanchez, J., Singer, J., Gafni, A., Gruslin, A., Helewa, M., Hutton, E., Lee, S. K., Lee, T., Logan, A. G., Ganzevoort, W., Welch, R., Thornton, J. G., & Moutquin, J.-M.
- Affiliations
- University of British Columbia (CA)
- University of Alberta (CA)
- University of Toronto (CA)
- McMaster University (CA)
- University of Ottawa (CA)
- University of Manitoba (CA)
- University of Amsterdam (NL)
- Derriford Hospital (GB)
- University of Nottingham (GB)
- Université de Sherbrooke (CA)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2015-01-29
- Volume
- 372
- Issue
- 5
- Pages
- 407-417
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2135528524
- Cited by
- 672
- References
- 23
- Citations by year
- 2026: 37 · 2025: 52 · 2024: 47 · 2023: 67 · 2022: 76 · 2021: 56 · 2020: 56 · 2019: 65 · 2018: 74 · 2017: 57 · 2016: 52 · 2015: 31
- FWCI
- 81.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Repository@Nottingham (University of Nottingham) (publishedVersion, other-oa)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Nottingham ePrints (University of Nottingham) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Funders
- Canadian Institutes of Health Research (87522_1)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Keywords
- hypertension in pregnancy, blood pressure control, tight blood pressure control, gestational hypertension, pre-existing hypertension, miscarriage, neonatal intensive care, maternal complications, severe hypertension in pregnancy, antihypertensive therapy, postpartum complications, preeclampsia, eclampsia
- MeSH terms
- Abortion, Spontaneous, Adult, Antihypertensive Agents, Blood Pressure, Female, Humans, Infant, Newborn, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Puerperal Disorders, Intensive Care, Neonatal, Hypertension, Pregnancy-Induced, Perinatal Death
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