Body of Evidence in Favor of Adopting 130/80 mm Hg as New Blood Pressure Cut-Off for All the Hypertensive Disorders of Pregnancy.

Giovanni Sisti,Belinda Williams

doi:10.3390/medicina55100703

Abstract

The American College of Cardiology/American Heart Association (ACC/AHA) updated its guideline redefining the classification of hypertension and the blood pressure cut-off in 2017. The current cut-offs for stage 1 hypertension of 130 mm Hg systolic blood pressure or 80 mm Hg diastolic blood pressure replace the previous cut-offs of 140 mm Hg systolic blood pressure or 90 mm Hg diastolic blood pressure which were based on the ACC/AHA guidelines from 1988. However, the blood pressure cut-off for the obstetric population still remains as 140/90 mm Hg despite the scarcity of evidence for it. Recent American College of Obstetricians and Gynecologists (ACOG) bulletins for pregnant women have not reflected the new ACC/AHA change of guideline. We reviewed a mounting body of evidence prompting the implementation of the new ACC/AHA guidelines for the obstetric population. These studies examined maternal and fetal outcomes applying the new ACC/AHA guidelines during antepartum or postpartum care.

Highlights

Hypertensive disorders of pregnancy (HDP) occur in 10% of pregnancies in women of reproductive age globally [1]
We reviewed a mounting body of evidence prompting the implementation of the new ACC/AHA guidelines for the obstetric population
We have previously shown that the usage of the 140/90 mm Hg cut-off is affected by several flaws: it is not evidence-based, it is established upon the Joint National Committee (JNC) report guideline set in 1988 and does not reflect the recent American College of Cardiology/American Heart Association (ACC-AHA) task force guideline [9,10]

Summary

Introduction

Hypertensive disorders of pregnancy (HDP) occur in 10% of pregnancies in women of reproductive age globally [1] As such, they constitute one of the leading causes of maternal and perinatal mortality worldwide. The cut-off is systolic blood pressure of 140 mm Hg or more, or diastolic blood pressure of 90 mm Hg or more It is associated with poor perinatal outcomes including low birth weight, preterm delivery, higher perinatal mortality, and an increased risk for neonatal death. Preeclampsia occurs when blood pressure is greater than 140/90 mm Hg after 20 weeks of gestation It is accompanied by proteinuria, or signs/symptoms like right upper quadrant pain, persistent epigastric pain, severe headache, blurry vision, thrombocytopenia, elevated liver enzymes, renal insufficiency and pulmonary edema [2].

Study Design

A Study That Examined Patients in the Postpartum Period

Findings

Discussion

Conclusions