2017 ACC/AHA BP management guideline may improve gestational high Blood Pressure detection

2017 American College of Cardiology (ACC) and American Heart Association (AHA) guideline for the management of high (blood pressure) BP in nonpregnant adults may improve the detection of high gestational blood pressure as well, revealed a study published in the Journal Circulation Research.

In 2017 the ACC/AHA released a guideline for the management of high BP in nonpregnant adults using low blood pressure values to detect hypertension according to which high blood pressure should be treated earlier with lifestyle changes and in some patients with medication – at 130/80 mm Hg rather than 140/90. This new definition set by the guideline was not assessed in pregnant women.

To ascertain the impact of the new guideline on the diagnosis of gestational hypertension and the associated maternal and neonatal risks a team of researchers conducted a study that included 16 345 women from China. Systolic and diastolic BP of each woman were measured at up to 22 prenatal care visits across different stages of pregnancy. Logistic and linear regressions were used to estimate associations of blood pressure categories with the risk of preterm delivery, early-term delivery, and small for gestational age, and indicators of the maternal liver, renal, and coagulation functions during pregnancy.

Key findings

• The authors identified 4100 (25.1%) women with gestational hypertension using the 2017 ACC/AHA guideline, compared with 4.2% using the former definition.


• Gestational hypertension, but not elevated blood pressure (subclinical blood pressure elevation), was significantly associated with altered indicators of liver, renal, and coagulation functions during pregnancy for mothers and increased risk of adverse birth outcomes for newborns;


• Adjusted odds ratios (95% CIs) for gestational hypertension stage 2 were 2.23 (1.18–4.24) for preterm delivery, 2.05 (1.67–2.53) for early-term delivery, and 1.43 (1.13–1.81) for small for gestational age.

Based on the results the authors conclude that "Adopting the 2017 ACC/AHA guideline would result in a substantial increase in the prevalence of gestational hypertension; subclinical blood pressure elevations during late pregnancy were not associated with increased maternal and neonatal risk in this cohort. Therefore, the 2017 ACC/AHA guideline may improve the detection of high blood pressure during pregnancy and the efforts to reduce maternal and neonatal risk. Replications in other populations are required."

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