Lower diagnostic threshold for hypertension improves recogni
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The 2017 American College of Cardiology/American Heart Association guidelines for hypertension identified more patients at risk for preeclampsia than the American College of Obstetricians and Gynecologists’ definition, researchers found.

ACOG defines hypertension as BP of 140/90 mm Hg or higher and severe hypertension as BP of 160/110 mm Hg or higher, told researchers.

“In 2017 the ACC/AHA recommend lowering the diagnostic threshold for stage 1 hypertension to 130/80 mm Hg,” she said. “This is considered prehypertension by ACOG.”

To compare how effectively the ACC/AHA guidelines and ACOG definition identify pregnant patients at risk for preeclampsia or eclampsia, Bello and colleagues conducted a retrospective cohort study of 137,389 pregnant patients (mean age at time of delivery, 30.1 years; 51.6% Hispanic) who delivered singleton infants. The researchers used electronic health record data to calculate net reclassification indices and compare the ACC/AHA diagnostic threshold with the ACOG diagnostic threshold. The study’s primary endpoints were the development of preeclampsia or eclampsia and a composite of preterm birth, small for gestational age and neonatal ICU admission.

The prevalence of chronic hypertension was 14.3% when applying the ACC/AHA criteria vs. 4.3% with ACOG criteria, the researchers reported. Meanwhile, the prevalence of gestational hypertension was 13.8% with ACC/AHA criteria vs. 6% with ACOG criteria. Applying the ACC/AHA criteria resulted in a 17.8% absolute increase in the overall prevalence of hypertension, from 10.3% to 28.1%, according to the researchers.

“We found that women who were classified with gestational hypertension using the ACOG criteria who met diagnostic threshold for chronic hypertension using ACC/AHA criteria were at the highest risk of developing preeclampsia or eclampsia,” researchers said.

Among these patients, there was an adjusted risk ratio of 13.58 for developing preeclampsia. Overall, the researchers reported that the ACC/AHA criteria was associated with a 20.8% improvement in identifying preeclampsia/eclampsia risk, as well as a 3.8% improvement in identifying fetal and neonatal risks.

“Using a lower threshold may reclassify women at risk and potentially identify those who could benefit from low-dose aspirin for preeclampsia prophylaxis,” author said. “But future prospective studies are needed to test this hypothesis.”

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2777974
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