Perhaps the most important and most actionable trial #ACC22 is Chronic Hypertension and Pregnancy (CHAP) Trial. Blood pressure control matters in pregnancy. This needs to be put into action. Next in line of great recent BP trials. nejm.org/doi/pdf/10.105… @ACCinTouch @NEJM 
@ACCinTouch @NEJM In this study @atitapatterns and colleagues randomized 2408 women w/chronic htn to target <140/90 or usual care (unless BP ≥160/105). Outcomes improved substantially with strategy of targeting <140/90. 18% reduction in risk for primary outcome. @nih_nhlbi @NICHD_NIH
@ACCinTouch @NEJM @atitapatterns @nih_nhlbi @NICHD_NIH Here is the blood pressure in the trial…at baseline SBP was ~134 mm Hg. About 56% diagnosed and receiving medication. SBP randomization to delivery lower in active-Rx group (129.5 vs 132.6 and 81.5 vs 81.5). That’s not much, but yet, yielded benefit.
@ACCinTouch @NEJM @atitapatterns @nih_nhlbi @NICHD_NIH Here are the blood pressure differences… and this seemed to translate into the 18% relative benefit… and 7 point difference in primary outcome (30.2% vs 37.0%).
@ACCinTouch @NEJM @atitapatterns @nih_nhlbi @NICHD_NIH Primary outcome was a composite of preeclampsia with severe
features, medically indicated preterm birth at less than 35 weeks’ gestation, placental abruption, or fetal or neonatal death. And I was shocked to see the rates so high, even in the intervention group… 30.2%.
features, medically indicated preterm birth at less than 35 weeks’ gestation, placental abruption, or fetal or neonatal death. And I was shocked to see the rates so high, even in the intervention group… 30.2%.
@ACCinTouch @NEJM @atitapatterns @nih_nhlbi @NICHD_NIH And then this...'The incidence of serious maternal complications 2.1% & 2.8%, respectively (RR, 0.75; 95% CI, 0.45 to 1.26) & incidence of severe neonatal complications 2.0% and 2.6% (RR, 0.77;95% CI, 0.45 to 1.30).’ So high. And BP control probably beneficial for these too.
@ACCinTouch @NEJM @atitapatterns @nih_nhlbi @NICHD_NIH Congrats to @atitapatterns and team. Blood pressure control really is a key tareget for prevention … at all ages… and we can do so much better. And so related to equity. A clear focus for us @YaleCardiology with @yuan_lu1 @SpatzErica Oyere Ounuma and many others. @YaleMed
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