Prepared by:
San Antonio Evidence-based Practice Center based at the University of Texas Health Science Center at San Antonio
Cynthia D. Mulrow, M.D., M.S.c.
Program Director
Elaine Chiquette, Pharm.D.
Project Director
Robert L. Ferrer, M.D., M.P.H.
Baha M. Sibai, M.D.
Kathleen R. Stevens, R.N., Ed.D.
Molly Harris, M.A., M.L.S.
Kelly A. Montgomery, M.P.H.
Karen Stamm, B.A.
Investigators
File Name Description Software Version File Size __________________________________________________________________________________________________________ 01front.wpd WordPerfect® Document Corel WordPerfect® 6/7/8 34KB 10 pages Contents: Cover Page, Title Page, Preface, Acknowledgments, Structured Abstract __________________________________________________________________________________________________________ 02cont.wpd WordPerfect® Document Corel WordPerfect® 6/7/8 24KB 6 pages Contents: Table of Contents __________________________________________________________________________________________________________ 03summ.wpd WordPerfect® Document Corel WordPerfect® 6/7/8 39KB 9 pages Contents: Summary: Overview, Reporting the Evidence, Methodology, Findings, Future Research __________________________________________________________________________________________________________ 04intro.wpd WordPerfect® Document Corel WordPerfect® 6/7/8 35KB 4 pages Contents: Chapter 1. Introduction: Purpose of Report and Target Audience; Definition and Classification of Chronic Hypertension; Natural History of Blood Pressure in Pregnancy; Epidemiology, Burden of Illness, Risks, and Economic Impact; Current Management and Variation in Practice; Challenges in Interpreting Research Evidence __________________________________________________________________________________________________________ 05method.wpd WordPerfect® Document Corel WordPerfect® 6/7/8 73KB 11 pages Contents: Chapter 2. Methodology: Questions Addressed in Evidence Report, Literature Search and Selection Methods, Table 1. Questions and selection criteria grouped by search strategies, Table 2. Electronic sources searched, (Figure 1 in separate file), Data Abstraction Process, Unpublished Data, Data Analysis Process __________________________________________________________________________________________________________ 06fig1.doc Microsoft Word® Document MS Word® 97 SR-1 26KB 1 page Contents: Figure 1. Flow diagram of selection process (Chapter 2) __________________________________________________________________________________________________________ 07result.doc Microsoft Word® Document MS Word® 97 SR-1 887KB 56 pages Contents: Chapter 3. Results: Question 1: Hypertension Management Before Pregnancy; Table 3. Morbidity and mortality results of antihypertensive trials for 8,565 women ages 30-54; Question 2: Outcomes With Antihypertensive Agents; Figure 2. Selection process for antihypertensive treatment trials; Table 4. Drug dosages and secondary regimens from antihypertensive trials in chronic hypertension in pregnancy; Table 5. Methodological characteristics of antihypertensive trials; Table 6. Total number of participants treated with particular antihypertensive agents in randomized trials; Table 7. Baseline blood pressure and response to treatment in antihypertensive trials of chronic hypertension in pregnancy; Figure 3. Perinatal death results of trials given as risk differences between antihypertensive treatment groups and control groups; Figure 4. Preeclampsia results of trials given as risk differences between antihypertensive treatment groups vs. control groups; Figure 5. Birthweights of treatment and control groups; Figure 6. Small-for-gestational age results of trials given as risk differences between antihypertensive treatment groups vs. control groups; Question 3: Potential Harm From Pharmacological Treatment; Figure 7. Selection process for studies assessing adverse effects; Table 8. Teratogenicity risk; Table 9. Serious fetal and neonatal adverse reactions; Table 10. Maternal serious adverse reactions during pregnancy; Table 11. U.S. Food and Drug Administration pregnancy categories definitions; Table 12. Australian pregnancy categories definitions; Table 13. Briggs, Freeman, and Yaffee pregnancy categories definitions; Question 4: Effects of Specific Antihypertensive Agents; Table 14. Balance sheet of benefits and harms of antihypertensive agents; Question 5: Nonpharmacological Treatment and Outcomes; Question 6: Nonpharmacological vs. Pharmacological Treatment; Question 7: Combination Treatment; Question 8: Blood Pressure Levels and Treatment; Figure 8. Selection process for studies addressing blood pressure level to initiate and maintain treatment; Figure 9. Perinatal death outcome results given as the relative risk (log scale) associated with chronic hypertension compared with either normotensive or general obstetrical populations; Table 15. Summary random effects odds ratios of perinatal mortality risks derived from studies comparing outcomes in women with chronic hypertension with women who were either normotensive or from a general obstetrical population; Figure 10. Abruption outcome results given as relative risk (log scale) associated with chronic hypertension compared with normotensive or general obstetrical populations; Question 9. Benefits of Aspirin; Figure 11. Selection process for aspirin prophylaxis studies; (Table 16 in separate file); Table 17. Design characteristics of aspirin trials; (Figure 12 in separate file); Figure 13. Preeclampsia results of trials: Risk difference between aspirin prophylaxis groups vs. control groups; Figure 14a. Intrauterine growth retardation results of trials: Risk differences between aspirin prophylaxis groups vs. control groups; Figure 14b. Small-for-gestational-age results of trials: Risk differences between aspirin prophylaxis groups vs. control groups; Figure 14c. Birthweight results of trial: Mean difference between aspirin prophylaxis groups vs. control groups; Figure 15. Perinatal deaths results of trials: Risk differences between aspirin prophylaxis groups vs. control groups; Figure 16. Preterm delivery results of trials: Risk differences between aspirin prophylaxis groups vs. control groups; Question 10: Use of Special Monitoring Techniques; Figure 17. Selection process for studies addressing fetal/maternal monitoring techniques __________________________________________________________________________________________________________ 08tab16.doc Microsoft Word® Document MS Word® 97 SR-1 29KB 1 page Contents: Table 16. Summary of aspirin trials (Chapter 3) __________________________________________________________________________________________________________ 09fig12.doc Microsoft Word® Document MS Word® 97 SR-1 46KB 1 page Contents: Figure 12. Rates of preeclampsia observed in chronic hypertensive vs. all high-risk participants in various aspirin trials (Chapter 3) __________________________________________________________________________________________________________ 10conclu.wpd WordPerfect® Document Corel WordPerfect® 6/7/8 26KB 4 pages Contents: Chapter 4. Conclusions: Benefits of Treating Hypertension Preconception; Benefits of Treating Hypertension During Pregnancy; Adverse Effects of Antihypertensive Agents; Effects of Nonpharmacological Interventions; Optimum Levels for Initiating Therapy and Risks of Elevated Blood Pressure; Effects of Low-Dose Aspirin; Special Monitoring Techniques; Summary Implications __________________________________________________________________________________________________________ 11future.wpd WordPerfect® Document Corel WordPerfect® 6/7/8 23KB 4 pages Contents: Chapter 5. Future Research __________________________________________________________________________________________________________ 12refs.wpd WordPerfect® Document Corel WordPerfect® 6/7/8 145KB 17 pages Contents: References __________________________________________________________________________________________________________ 13etab1.doc Microsoft Word® Document MS Word® 97 SR-1 146KB 13 pages Contents: Evidence Table 1. Studies evaluating risks of chronic hypertension __________________________________________________________________________________________________________ 14biblio.wpd WordPerfect® Document Corel WordPerfect® 6/7/8 243KB 58 pages Contents: Bibliography __________________________________________________________________________________________________________ 15appa.wpd WordPerfect® Document Corel WordPerfect® 6/7/8 375KB 23 pages Contents: Appendix A. Search Strategies __________________________________________________________________________________________________________ 16appb.wpd WordPerfect® Document Corel WordPerfect® 6/7/8 51KB 11 pages Contents: Appendix B. Contributors __________________________________________________________________________________________________________ 17appc.wpd WordPerfect® Document Corel WordPerfect® 6/7/8 3KB 2 pages Contents: Appendix C. Acronyms and Abbreviations __________________________________________________________________________________________________________ 18appd.wpd WordPerfect® Document Corel WordPerfect® 6/7/8 162KB 6 pages Contents: Appendix D. Glossary __________________________________________________________________________________________________________
AHRQ Publication No. 00-E011
Current as of August 2000
Internet Citation:
Management of Chronic Hypertension During Pregnancy. File Inventory, Evidence Report/Technology Assessment Number 14. AHRQ Publication No. 00-E011, August 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/hyperinv.htm
Return to Evidence-based Practice
Clinical Information
AHRQ Home Page
Department of Health and Human Services