News from ACOG 2018: Aspirin cuts down the risk of superimposed preeclampsia in women with chronic hypertension

Keeping up with the American College of Obstetricians and Gynecologists (ACOG) 2016 practice guideline of supplementing low-dose aspirin to pregnant women with chronic hypertension was associated with a 57% decrease in superimposed preeclampsia.

Investigators at Thomas Jefferson University presented the results of this retrospective study in a poster presentation at the ACOG 2018 annual meeting (April 27–30, 2018, Austin, Texas).

The study participants included 715 women with chronic hypertension carrying singleton pregnancy, who delivered at Thomas Jefferson University Hospital between January 2008 to July 2017.

The women were divided into 2 groups based on whether they delivered before and after ACOG recommendations. The pre-ACOG group included 635 women while the post-ACOG group had 80 women.

The cohort was further stratified based on additional risk factor for the development of superimposed preeclampsia (SIP) like a previous history of preeclampsia or pregestational diabetes. The primary outcome of interest was the development of preeclampsia, while the secondary outcomes studied were the incidence of SIP with severe features (SIPSF), small for gestational age, and preterm birth was also studied.

The incidence of SIP was dramatically reduced by 57% in women with chronic HT who received low dose aspirin (OR 0.43 (95% CI 0.26-0.73).

Women who had no other risk factor for the development of SIP, the incidence of SIP and SIP with severe features decreased by 75% and 77% respectively.

The incidence of secondary outcomes did not show any significant changes. Aspirin showed the highest benefits in women with chronic hypertension who did not have any additional risk factor for preeclampsia.

Hence the authors concluded that this study showed that ACOG guidelines have a significant positive impact on bringing down the incidence of superimposed preeclampsia in patients with chronic hypertension.

Abstract

ACOG Practice Advisory on Low-Dose Aspirin and Prevention of Preeclampsia

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The American Heart Association updates BP guidelines in 14 years: now 130 is the new 140

The American Heart Association (AHA)  and The American College of Cardiology (ACC) has changed the definition of hypertension for the first time in 14 years, moving the number from the old standard of 140/90 to the newly revised 130/80.

According to the new definition, 130 to 139 mm Hg systolic and or 80 to 89 mm Hg will be labelled as stage 1 hypertension.

The guidelines were released here at the American Heart Association(AHA) 2017 Scientific Sessions : November 11–15, 2017, Anaheim, California and published simultaneously in the Journal of the American College of Cardiology,and in the AHA journal Hypertension.

The definition of the normal blood pressure has not changed in the new classification , but the new guidelines eliminate the class of ‘ pre-hypertension’.

Previously a systolic pressure between 120 and 129 and diastolic pressure less than 80 mm Hg was classified as pre-hypertension, now it is defined as elevated BP and a systolic pressure 130 to 139 or a diastolic pressure of 80 to 89 mm Hg is labelled as stage 1 hypertension.

This new classification raises the prevalence of hypertension from 31.9% to 45.6% and number of Americans with hypertension from 72.2 to 103.3 million.

In patients who are labelled as stage 1 hypertension, the treatment will be guided by underlying cardiovascular risk: only those with clinical cardiovascular disease or an estimated risk of 10% or more of atherosclerotic cardiovascular disease (ASCVD) would be offered treatment, and the remainder should be given advice on lifestyle modification.

Dr Robert M Carey (University of Virginia School of Medicine), Vice-chair of the writing committee said in a briefing, "Lifestyle modification is the cornerstone of the treatment of hypertension, and we expect that this guideline will cause our society and our physician community to really pay attention much more to lifestyle recommendations."

Specific recommendations include advice to lose weight, follow a DASH-pattern diet, reduce sodium to less than 1500 mg/day and increase potassium intake to 3500 mg/day through dietary intake, increase physical activity to a minimum of 30 minutes of exercise three times per week, and limit alcohol intake to two drinks or less per day for men and one or less for women.

The new goals of treating hypertension has also decreased since the last guideline, lowering it  from 140/90 mm Hg  to a target of 130/80 mm Hg.

The guidelines were developed after a thorough and systematic scientific review of over 900 publications over 3 years and felt that lowering the BP limit will improve the cardiovascular health of all Americans.

The notable studies were  SPRINT and ACCORD trials, in which lowering the blood pressure reduced CVD morbidity and mortality without any increased risk for falls or orthostatic hypotension.

New release by AHA

Full text PDF in Journal Hypertension 

                     Understanding the 2017 Hypertension Guidelines