Choice Of Antihypertensive Drugs Research Articles

Diuretic of Choice in ABFM Hypertension Self-Assessment Module Simulations

Evidence suggests that chlorthalidone has therapeutic advantages over hydrochlorothiazide, perhaps because of a longer antihypertensive effect. Although guidelines such as the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure treat diuretics as a class, some experts believe chlorthalidone is the diuretic of choice in hypertension management. We evaluated diplomates' use of chlorthalidone and hydrochlorothiazide as first-choice diuretics in virtual patient simulations of hypertension in the American Board of Family Medicine Maintenance of Certification for Family Physicians self-assessment modules. We examined action logs for hypertension simulations completed between 2004 and 2011 and identified initial antihypertensive choices made by diplomates. We tabulated uses of any diuretic as initial treatment, distinguishing between chlorthalidone, hydrochlorothiazide, and other diuretic choices. We examined trends in the use of diuretics and chlorthalidone in simulations using linear models. Chlorthalidone use increased 0.7 percentage points per year (test for β >0, P < .0013), from approximately 1.3% of simulation prescriptions in 2004 to about 4.8% in 2010 and 2011, whereas hydrochlorothiazide prescriptions fell 2 percentage points per year (P = .035), from nearly 57% to 47%. As a fraction of all diuretic use, chlorthalidone increased 1.4 percentage points per year (P = .0006), from 2% to 9%. Small but growing numbers of diplomates are heeding recommendations in the growing literature to start with chlorthalidone rather than hydrochlorothiazide, at least in the virtual patient environment. Observed choices in virtual patient management strongly imply that this is a valid topic for additional attention in the hypertension self-assessment module.

Antihypertensive Drugs in Patients Treated with Antiretroviral

To review the literature for information regarding pharmacokinetic interactions between antiretrovirals and antihypertensive agents, evaluate the clinical significance of these interactions, and analyze the effect of antihypertensive drugs on the metabolic complications frequently observed in HIV-infected patients to emphasize the advantages and inconveniences of every class of antihypertensive drugs in association with antiretrovirals. A literature search was conducted via PubMed and MEDLINE (1950-November 2011) using the search terms drug interactions, cytochrome P450, names of antiretrovirals, names of commonly prescribed antihypertensive drugs, pharmacokinetics, and metabolic complications. Reference citations from relevant publications, manufacturers' product information, and www.HIV-druginteractions.org were also reviewed. STUDY SELECTION AND DATA EXTRACTIONS: All articles with an English abstract identified through the data search were examined. Of these, pharmacologic reviews, studies, and case reports were evaluated. Antihypertensive drugs interact with several antiretroviral drugs, nonnucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) in particular. Pharmacokinetic interactions are less expected with diuretics, β-blockers excreted by the kidney, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs) other than losartan and irbesartan. Calcium channel blockers (CCBs) are metabolized by CYP3A4, with the potential for interaction with NNRTIs and PIs. Because CCBs do not adversely affect glucose or lipid metabolism or renal function, they may be preferred in patients with such complications. ACE inhibitors and ARBs may exert favorable effects on glucose homeostasis. In addition, they may significantly reduce protein excretion and further slow the progression of renal disease. The choice of antihypertensive drugs in HIV-infected patients is complex and must take into account the metabolic pathways of antiretroviral drugs and antihypertensive drugs with the potential of pharmacokinetic interactions, as well as the effect of antihypertensive drugs on some biological parameters.

Choice of generic antihypertensive drugs for the primary prevention of cardiovascular disease--a cost-effectiveness analysis.

BackgroundHypertension is one of the leading causes of cardiovascular disease (CVD). A range of antihypertensive drugs exists, and their prices vary widely mainly due to patent rights. The objective of this study was to explore the cost-effectiveness of different generic antihypertensive drugs as first, second and third choice for primary prevention of cardiovascular disease.MethodsWe used the Norwegian Cardiovascular Disease model (NorCaD) to simulate the cardiovascular life of patients from hypertension without symptoms until they were all dead or 100 years old. The risk of CVD events and costs were based on recent Norwegian sources.ResultsIn single-drug treatment, all antihypertensives are cost-effective compared to no drug treatment. In the base-case analysis, the first, second and third choice of antihypertensive were calcium channel blocker, thiazide and angiotensin-converting enzyme inhibitor. However the sensitivity and scenario analyses indicated considerable uncertainty in that angiotensin receptor blockers as well as, angiotensin-converting enzyme inhibitors, beta blockers and thiazides could be the most cost-effective antihypertensive drugs.ConclusionsGeneric antihypertensives are cost-effective in a wide range of risk groups. There is considerable uncertainty, however, regarding which drug is the most cost-effective.

Choice of initial antihypertensive drugs and persistence of drug use—a 4-year follow-up of 78,453 incident users

To investigate patterns of initial drug therapy for the treatment of hypertension and to evaluate treatment persistence and change of treatment during a 4-year period in patients receiving thiazides (TZs) and/or angiotensin II-receptor blockers (ARBs) as first-line treatment. All initial users of antihypertensive drugs in 2005 and 2009 registered in the Norwegian Prescription Database were included. Treatment on five index dates at 1-year intervals was recorded. A patient was considered to be under treatment on an index date if a drug had been dispensed within the previous 180 days and to have maintained treatment persistence if he/she was on any antihypertensive treatment on the index date and all previous index dates. Among 78,453 new users of antihypertensives in 2005, women started more often with TZs than men (30 vs. 25 %) and less often with ARBs (22 vs. 25 %). In men, the hazard of non-persistence with antihypertensive treatment was significantly lower among initial ARB users than among TZ users (hazard ratio 0.87, 95 % confidence interval 0.81-0.94); in women no significant difference was found. After 4 years, 49 % of the men and 51 % of the women who had started with plain TZs were still using TZs, whereas 65 % of the male ARB users and 60 % of the female ARB users were still using ARBs. TZs and ARBs were the most widely used first-line antihypertensives. Among the men enrolled in the study, ARB users had a somewhat better persistence with antihypertensive treatment than TZ users. Among both genders, continuation on ARBs was more common than continuation on TZs.

Antihypertensive Prescribing Patterns for Adolescents With Primary Hypertension

Hypertension is an increasingly common problem in adolescents yet current medical management of primary hypertension in adolescents has not been well-described. We identified adolescents with primary hypertension by International Classification of Diseases, Ninth Revision codes and looked at prescription patterns chronologically for antihypertensive drug class prescribed and the specialty of prescribing physician. We also examined patient demographics and presence of obesity-related comorbidities. During 2003-2008, there were 4296 adolescents with primary hypertension (HTN); 66% were boys; 73% were aged 11 to 14 years; 53% were black, 41% white, and 4% Hispanic; and 48% had obesity-related comorbidity. Twenty-three percent (977) received antihypertensive prescription. White subjects (odds ratio [OR]: 1.61; confidence interval [CI]: 1.39-1.88), older adolescents (≥15 years, OR: 2.11; CI: 1.79-2.48), and those with comorbidity (OR: 1.57; CI: 1.36-1.82) were more likely to receive antihypertensive prescriptions controlling for gender and years of Medicaid eligibility in logistic regression. Angiotensin converting enzyme inhibitors were the most frequently prescribed monotherapy. Nearly two-thirds of adolescents received prescriptions from adult primary care physicians (PCPs) only. More than one-quarter of adolescents who received a prescription received combination therapy, which was most often prescribed by adult PCPs. Adult PCPs were the leading prescribers of antihypertensives for adolescents with primary HTN. Race differences exist in physicians' prescribing of antihypertensives to adolescents with primary HTN. The choice of antihypertensives by physicians of different specialties warrants additional study to understand the underlying rationale for treatment decisions and to determine treatment effectiveness.

Losartan versus atenolol-based antihypertensive treatment reduces cardiovascular events especially well in elderly patients

The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study has previously demonstrated a beneficial effect of losartan compared to atenolol-based antihypertensive treatment in patients with essential hypertension and left-ventricular hypertrophy (LVH). However, patient age often influences the choice of antihypertensive drugs. Therefore, we investigated the influence of age on the effects of losartan versus atenolol-based antihypertensive treatment. A total of 9193 hypertensive patients with LVH aged 45-83 years were followed for a mean of 4.8 years. Blood pressure, high-density lipoprotein cholesterol (HDL-C), Sokolow-Lyon voltage, Cornell voltage-duration product and urine albumin-creatinine ratio (UACR) were measured yearly throughout the study. Patients were divided into two age groups according to the median age of 67 years and the effects of losartan versus atenolol-based antihypertensive treatment on the primary composite endpoint (CEP) consisting of cardiovascular death, nonfatal stroke or nonfatal myocardial infarction were investigated. The beneficial effect of losartan versus atenolol-based treatment was greater in the group of patients older than 67 years [hazard ratio 0.79 (0.69-0.91), P = 0.001] compared to the group of patients younger than 67 years [hazard ratio 1.03 (0.82-1.28), P = 0809], P = 0.045 for interaction. The beneficial effects of losartan versus atenolol-based antihypertensive treatment on pulse pressure, HDL-C, UACR, and Cornell and Sokolow-Lyon voltage were not more pronounced in patients older than 67 years compared to patients younger than 67 years. All five risk factors considered as time-varying covariates predicted CEP independently (P < 0.01) with the exception of pulse pressure (P = 0.37) and the interaction between age and treatment on outcome remained significant (P = 0.042). We showed a greater beneficial effect of losartan versus atenolol-based antihypertensive treatment in the group of patients older than 67 years compared to the group of patients younger than 67 years. This difference was not explained by a more pronounced effect of losartan-based treatment on any of the cardiovascular risk factors demonstrated to have independent prognostic importance.

Diltiazem in the treatment of hypertension and ischemic heart disease

Treatment of patients with hypertension and ischemic heart disease should be focused not only on the control of overall cardiovascular risk factors, particularly blood pressure, but also on eliminating anginal symptoms, or at least reducing them, as angina symptoms have a crucial prognostic value. Although the amount of blood pressure reduction, rather than the choice of antihypertensive drug, is the major determinant of reduction of cardiovascular risk, some drugs such as β-blockers should be preferably used in patients with angina. However, β-blockers are contraindicated or produce intolerable side effects in many patients. Although, in the last years, new drugs for the treatment of stable angina have emerged, diltiazem should remain as a good alternative in the treatment of these patients. In this article, available evidence regarding diltiazem in the treatment of hypertension and ischemic heart disease is updated.

Individual approach to antihypertensive drug choice in hypertensive patients based on individual features of autonomic cardiovascular dysfunction

Objective. Development of differentiated method for selection of antihypertensive drugs in hypertensive patients based on assessment of individual features of autonomic cardiovascular dysfunction evaluated by spectral parameters of heart rate variability (HRV) and synchronization of 0.1 Hz oscillation in heart rate and microcirculation. Design and methods. 105 patients with arterial hypertension stage 1-2 aged 47 ± 8 years were examined. 0.1 Hz oscillations in heart rate and microcirculation were registered during passive tilt test under spontaneous breathing. The signals were recorded before and after three-week treatment by angiotensin-converting enzyme (ACE) inhibitors (fosinopril or enalapril) and β-blockers (atenolol or metoprolol). Phase differences between 0.1 Hz oscillations were used to measure the synchronization index S . Power of low- (LF) and high-frequency (HF) bands of HRV spectrum was also assessed. Results. ACE inhibitors are preferred for treatment of hypertensive patients with initially severe systemic autonomic dysfunction (index S is 250 ms 2 in supine position). β-blockers are recommended for patients with initially severe systemic autonomic dysfunction and dysfunction of autonomic heart regulation (index S 2 in vertical body position). If severe autonomic dysfunction (index S is > 25 % and power of LF band of HRV spectrum is > 250 ms 2 ) is not present the treatment by ACE inhibitors and β-blockers is not recommended. Conclusions. The type of antihypertensive drugs (ACE inhibitors or β-blockers) should be selected based on individual features of autonomic cardiovascular dysfunction. Sensitivity and specificity of this method was 65 and 73 %, respectively.

Antihypertensive Drugs in Pregnancy

Blood pressure targets and medications that are safe differ in pregnant women compared with nonpregnant individuals. The principles of treatment for mild, moderate, and severe hypertension in pregnancy, chronic versus gestational versus preeclampsia, and women hypertensive at term versus remote from term are reviewed. The choice of antihypertensive drugs also is discussed; methyldopa, labetalol, and nifedipine, among others, appear safe for use in pregnancy, whereas angiotensin converting enzyme inhibitors and angiotensin receptor blockers should be avoided. The management of increased blood pressure in the postpartum period, and agents to use in lactation, are also discussed.

Design and Rationale of a Real-Life Study to Compare Treatment Strategies for Cardiovascular Risk Factors: The CRUCIAL Study

The CRUCIAL trial was designed to compare the relative reduction in calculated Framingham coronary heart disease risk when a multiple risk factor intervention strategy, based on single-pill amlodipine besylate/atorvastatin calcium, was compared with a usual-care strategy. Eligible patients had treated or untreated hypertension, ≥ 3 additional cardiovascular risk factors, and baseline total cholesterol ≤ 6.5 mmol/L, but no coronary heart disease. The CRUCIAL trial was a 12-month, international, multicenter, prospective, stratified, cluster-randomized, parallel-design, open-label trial conducted in 20 countries in Asia, the Middle East, Europe, and Latin America. We anticipate the results of this study will be available in mid to late 2010. In this article we report the rationale for and design of the CRUCIAL trial and discuss how the challenges in the design and conduct of this cluster-randomized trial were addressed. The cluster-randomized trial design, with the investigator as the unit of randomization, was chosen to minimize contamination between the trial arms. The intent of the study was to compare the new therapeutic strategy with customary treatment practices, so no recommendation was made regarding the choice of antihypertensive or lipid-lowering drugs in the usual-care arm. It was considered that if the investigator managed both arms of the trial it would be difficult to prevent crossover of treatment strategies. Patients were enrolled in the study before the investigators were randomized to avoid selection bias. Investigators were randomized in a 1:1 ratio within each country to explicitly balance the treatment arms with respect to potential confounding factors. The cluster effect was taken into account in the sample size calculation. The findings from the CRUCIAL trial have the potential to inform current thinking on how to effectively reduce the cardiovascular risk of patients with hypertension and additional risk factors but only modestly elevated total cholesterol.

Reappraisal of the European guidelines on hypertension management. The European Society of Hypertension Task Force document: a short review

The European Society of Hypertension Task Force document on reappraisal of the 2007 European guidelines on hypertension addresses a number of studies published in the last 2 years to estimate their contribution to the expanding knowledge on hypertension. The importance of total cardiovascular risk with inclusion of subclinical cardiac, vascular, and renal organ damage was reemphasized, followed by a critical reappraisal of recommendations for the initiation of antihypertensive drug treatment in patients with high normal blood pressure (BP) and grade 1 hypertension. Whereas there is sufficient evidence for reducing BP below 140/90 mmHg in most hypertensives, the recommendation of previous guidelines to aim at a lower BP in diabetics and in patients at very high cardiovascular risk is not consistently supported by trial evidence. Moreover, the J-curve phenomenon may occur in patients at high cardiovascular risk. With regard to the choice of antihypertensive drugs, the conclusions of the 2007 guidelines that diuretics, angiotensin-converting enzyme inhibitors, calcium antagonists, angiotensin receptor antagonists, and beta-blockers are suitable for initiation and maintenance of antihypertensive treatment are reinforced. Furthermore, apart from starting with combination therapy in certain conditions, adding a drug from another class to the initially prescribed one is preferred to increasing the dose of the first one. Some of the drug combinations recommended in 2007 are now regarded as more recommendable. In addition to the benefits of antihypertensive treatment in the elderly, the HYVET (Hypertension in the Very Elderly Trial) has shown that antihypertensive treatment also has benefits in octogenarians. The document ends with a number of issues in urgent need to be approached by new trials.

HOW TO TREAT HYPERTENSION IN BLACKS: REVIEW OF THE EVIDENCE

Presentation, response to therapy, and clinical outcome differ according to race for patients with hypertension.Black patients have a higher prevalence and earlier onset of hypertension than other ethnic groups, with poorer prognosis than white patients. Blacks are more likely to be salt-sensitive, and to have a low plasma renin activity than are whites. They are at much greater risk of developing cardiovascular and renal complications. Despite many advances in the understanding and treatment of cardiovascular diseases, black patients continue to have increased morbidity and mortality from the end-organ complications of hypertension. The explanations for these observations remain incompletely understood, but genetic differences, added to socio-economic and environmental factors, have been proposed to explain this disparity.The first therapeutic approach is to decrease salt and increase potassium intakes. Diuretics (thiazides and potassium-sparing agents) and calcium channel blockers constitute the first antihypertensive drug choices. The angiotensin-converting-enzyme inhibitors, the angiotensin II receptor blockers and beta-blockers appear to be less effective in blacks with regard to uncomplicated hypertension, especially in older people, but addition of a small dose of diuretic improves their efficacy. These combinations are preferred among patients with chronic kidney disease or heart failure.The goal for blood pressure target is the same in blacks as it is in whites, being a blood pressure of less than 140/90 mmHg in uncomplicated hypertension and less than 130/80 mmHg in patients with diabetes mellitus or chronic kidney disease.

Treatment of hypertension in patients with peripheral arterial disease: An update

Hypertension is a known risk factor for cardiovascular events, and recent data have pointed to peripheral arterial disease (PAD) as another strong risk factor; together, they cause a surprisingly high total risk. This review deals with the clinical management of this dangerous association. The ankle-brachial index helps in the diagnosis of PAD and the estimation of risk. To control risk, lifestyle adaptation is essential. There is no consensus on a first choice of antihypertensive drug. Arguments favor angiotensin-converting enzyme inhibitors, but most patients require several antihypertensive drugs to reach goal pressure (140/90 mm Hg or lower). Moreover, to control the risk of PAD, antiplatelet drugs, antihypertensive drugs, and statins are recommended.

Management of Blood Pressure for Acute and Recurrent Stroke

Marc Fisher MD Kennedy Lees MD Section Editors: Hypertension is the most important modifiable risk factor for stroke.1,2 It is estimated that 25% or more of strokes may be attributable to hypertension. Because many patients with stroke have mild hypertension or prehypertension, we have shifted our focus and now think of stroke on a continuum of risk based on blood pressure (BP) level rather than on a threshold effect.3 Because high BP may not exist in isolation, a wider definition of hypertension has been proposed that also takes into account the absolute risk of cardiovascular events and associated metabolic factors or early disease markers.3 Lowering BP reduces the risk of stroke. Epidemiological studies have shown that for each 10 mm Hg lower systolic blood pressure (SBP), there is a decrease in risk of stroke of approximately one third in persons aged 60 to 79 years. This association is continuous down to levels of at least 115/75 mm Hg and is consistent across sexes, regions, stroke subtypes, and for fatal and nonfatal events.4 Lowering diastolic blood pressure (DBP) was once the main target to achieve stroke and other cardiovascular event reduction, but SBP has now become the target.3 As recently shown, even the elderly with sustained SBP elevation may gain from BP reduction in relation to less fatal or nonfatal stroke, death, and heart failure.5 Although the role of longer-term BP control to improve outcomes in patients with stroke is undisputed, BP management immediately after a stroke remains controversial. In an effort to resolve this controversy, several pilot clinical trials have been initiated. In this review, we discuss the results of some of these trials and available evidence-based guidelines for BP control in the settings of acute ischemic and hemorrhagic stroke (excluding subarachnoid hemorrhage) and …

Patient adherence and the choice of antihypertensive drugs: focus on lercanidipine

Despite the development of many effective antihypertensive drugs, target blood pressures are reached in only a minority of patients in clinical practice. Poor adherence to drug therapy and the occurrence of side effects are among the main reasons commonly reported by patients and physicians to explain the poor results of actual antihypertensive therapies. The development of new effective antihypertensive agents with an improved tolerability profile might help to partly overcome these problems. Lercanidipine is an effective dihydropyridine calcium channel blocker of the third generation characterized by a long half-life and its lipophylicity. In contrast to first-generation dihydropyridines, lercanidipine does not induce reflex tachycardia and induces peripheral edema with a lower incidence. Recent data suggest that in addition to lowering blood pressure, lercanidipine might have some renal protective properties. In this review we shall discuss the problems of drug adherence in the management of hypertension with a special emphasis on lercanidipine.

Choice of first antihypertensive – are existing guidelines ignored? Response to Vegter &amp; de Jong‐van den Berg.

We agree with the overall conclusions of Vegter et al. [1], whose data show a similar choice of first antihypertensives to that reported in Ireland. We now represent our data as requested, using likelihood to receive recommended therapy for ‘young males vs. old males’, which shows an odds ratio (OR) = 1.75 [95% confidence interval (CI) 1.63, 1.88] and for ‘young females vs. older females’, OR = 1.11 (95% CI 1.06, 1.17). We suggest that the reasons for similar findings in a number of different countries are not necessarily the same. For example, as distinct from the Netherlands, in Ireland we do not have pharmacotherapy audit meetings or strong national guidelines. However, we do agree that other factors may influence the choice of antihypertensive therapy. It is interesting to observe that, despite adverse publicity concerning β-blockers as first-line antihypertensive agents, in both countries, as seen in these studies, they have remained among the most popular antihypertensive groups [1, 2].

Diagnostic and therapeutic procedures by doctors for patients in a hypertensive crisis. An inquiry in 56 internal medicine clinics

Despite official guidelines on the diagnosis and treatment of hypertensive crisis, the extent to which they are being followed in routine medical practice is unknown. This study was undertaken to discover how hospital doctors were handling cases of hypertensive crisis (HC). Physicians were requested to participate in a multiple-choice questionnaire study, relating to the diagnosis of HC, any emergency diagnosis and choice of antihypertensive drugs, these questionnaires to be distributed among the medical staff. Ultimately 463 questionnaires (one per doctor) were sent out and 325 were completed (response rate of 70%). The most frequently mentioned blood pressure values characteristics for HC were > 200 systolic and > 120 diastolic. 160/90 was given most often as the therapeutic goal, which most doctors wanted to reach in an HC within 30 to 60 min. The calcium-antagonist nifedipine was the drug of first choice for almost all clinical presentations. Second was intravenously urapidil, an alpha-agonist. Nitroglycerin was named as first choice only for pulmonary oedema or myocardial infarction. In everyone of the stated conditions most doctors were eager to avoid using beta-blockers. As for the drug of first choice in associated myocardial infarction, 111 doctors named nifedipine, 28 wanted to avoid it and 45 considered it contraindicated. These data show a marked discrepancy between recommended guidelines and actual practice in the management of hypertensive crisis.

Choice of antihypertensive drugs in the European Society of Hypertension–European Society of Cardiology guidelines: specific indications rather than ranking for general usage

Choice of antihypertensive drugs in the European Society of Hypertension–European Society of Cardiology guidelines: specific indications rather than ranking for general usage

The Clinical Significance of Blood Pressure Lowering Treatment: Is First-Line Drug Choice Important?

According to the recommendations of the European Society of Hypertension/European Society of Cardiology guidelines on the diagnosis and management of hypertension, the major benefits of antihypertensive treatment are related to blood pressure reduction per se rather than to the specific drugs used. This article reviews this statement by discussing the evidence provided by a number of clinical trials that blood pressure reduction is more important than the antihypertensive drug choice in uncomplicated hypertensive patients. The difference between drugs will become increasingly important as the cardiovascular risk profile of the patient becomes elevated and/or when associated risk factors or concomitant target organ damage are detected.

An International Benchmarking Collaboration: Measuring Outcomes for the Hypertensive Disorders of Pregnancy

ObjectiveTo implement a set of clinical indicators to benchmark outcomes for women suffering from the hypertensive disorders of pregnancy. MethodsSeven clinical indicators were designed and applied retrospectively to data collected from two tertiary referral centres, Royal Prince Alfred Hospital, Sydney, Australia and British Columbia Women’s Hospital and Health Centre, Vancouver BC, for all women coded as hypertensive during pregnancy under the International Classification of Disease (ICD-10) coding system in the years 2002–2004. Diagnostic categories were assigned using the Australasian Society for the Study of Hypertension in Pregnancy criteria, expressed in equivalent Canadian terms drawn from the Report of the Canadian Hypertension Society Consensus. Comparisons were made using the established clinical indicators. Data analysis using chi-square comparison was performed with significance set at P < 0.05. Seven outcome measures of maternal and neonatal mortality and morbidity were compared. ResultsSignificant areas of difference between the two tertiary referral centres were seen in birth weights below the 10th centile (RPA 11% vs. BCW 20%; P < 0.05) and below the 3rd centile (RPA 1.5% vs. BCW 7.5%; P < 0.001). There were significantly more episodes of maternal pulmonary edema at BCW than at RPA (0.1% and 1.2%, respectively; P < 0.001). ConclusionBetween similar centres, clinically significant differences in outcomes for HDP were identified. Further evaluation of differences may lead to analysis of possible contributors such as expectant versus urgent delivery management policies, rigidity of blood pressure control, and choice of antihypertensive drug.