758 Hypertensive disease of pregnancy (HDP) among high risk women with stage 1 hypertension

Abstract

To evaluate HDP in high risk women with stage 1 hypertension (SBP 130-139 mmHg or DBP 80-89 mmHg) as defined by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Hypertension Guidelines. Previous investigations of low risk populations have correlated stage 1 hypertension with increased risk of poor obstetric outcomes, however high risk women have not been studied. We performed a secondary analysis of the "Low-dose aspirin to prevent preeclampsia in women at high risk" dataset, a multicenter randomized trial investigating aspirin (ASA) for the prevention of preeclampsia. High risk women with a diagnosis of insulin dependent diabetes (IDDM), chronic hypertension (CHTN), multifetal gestations (MG) or a history of preeclampsia (Hx Pre) who met criteria for stage 1 HTN at an initial prenatal visit between 13-26 weeks were randomized to baby aspirin (ASA) or placebo and compared to normotensive controls. The primary outcome was hypertensive disease in pregnancy (HDP) defined as gestational HTN, preeclampsia, and preeclampsia with severe features. Risk ratios and 95% CI were calculated. 2,053 high risk women were evaluated. 446 participants met criteria for stage 1 HTN and were compared to 1,309 normotensive controls. Among those in the placebo group, women with IDDM (RR 2.4 [1.6-3.5]), CHTN (RR 1.8 [1.1-3.0]) and Hx Pre (RR 2.0 [1.5-2.7]) demonstrated increased risk of HDP with a diagnosis of stage 1 HTN. Those with a history of preeclampsia and stage 1 HTN demonstrated increased risk for HDP in both the placebo and ASA group. ASA seemed to be effective in prevention of HDP for women with IDDM or CHTN. In patients with preexisting risk factors, stage 1 HTN at initial prenatal visit was an additive risk factor for hypertensive disease in pregnancy. ASA proves effective at preventing HDP in women with IDDM and CHTN who met criteria for stage 1 hypertension.