{"id":"94eccb4e7b5a","type":"article","url":"https://hartvaat.nl/2022/05/12/behandeling-van-milde-chronische-hypertensie-in-de-zwangerschap-nejm-chap/","title":"Behandeling van milde chronische hypertensie in de zwangerschap: NEJM CHAP","title_en":"Treatment for Mild Chronic Hypertension during Pregnancy.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["zwangerschap-hart"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2201295","source_url":"https://doi.org/10.1056/NEJMoa2201295","authors":["Alan T Tita","Jeff M Szychowski","Kim Boggess","Lorraine Dugoff","Baha Sibai","Kirsten Lawrence","Brenna L Hughes","Joseph Bell","Kjersti Aagaard","Rodney K Edwards","Kelly Gibson","David M Haas","Lauren Plante","Torri Metz","Brian Casey","Sean Esplin","Sherri Longo","Matthew Hoffman","George R Saade","Kara K Hoppe","Janelle Foroutan","Methodius Tuuli","Michelle Y Owens","Hyagriv N Simhan","Heather Frey","Todd Rosen","Anna Palatnik","Susan Baker","Phyllis August","Uma M Reddy","Wendy Kinzler","Emily Su","Iris Krishna","Nicki Nguyen","Mary E Norton","Daniel Skupski","Yasser Y El-Sayed","Dotum Ogunyemi","Zorina S Galis","Lorie Harper","Namasivayam Ambalavanan","Nancy L Geller","Suzanne Oparil","Gary R Cutter","William W Andrews"],"significance":10,"published":"2022-05-12","source_date":"2022-05-12","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"The CHAP trial demonstrated that treatment of mild chronic hypertension during pregnancy (targeting blood pressure <140/90 mmHg) significantly reduced the risk of preeclampsia and preterm birth with no adverse fetal effects. This landmark result reversed the prevailing watchful-waiting approach and established active treatment as beneficial in pregnancy-associated hypertension.","created":"2026-07-03T10:29:45Z","updated":"2026-07-03T13:28:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM CHAP trial die aantoonde dat behandeling van milde chronische hypertensie in de zwangerschap de uitkomsten significant verbetert. Verandert het beleid van watchful waiting naar actieve behandeling.","abstract_original":"BACKGROUND: The benefits and safety of the treatment of mild chronic hypertension (blood pressure, <160/100 mm Hg) during pregnancy are uncertain. Data are needed on whether a strategy of targeting a blood pressure of less than 140/90 mm Hg reduces the incidence of adverse pregnancy outcomes without compromising fetal growth. METHODS: In this open-label, multicenter, randomized trial, we assigned pregnant women with mild chronic hypertension and singleton fetuses at a gestational age of less than 23 weeks to receive antihypertensive medications recommended for use in pregnancy (active-treatment group) or to receive no such treatment unless severe hypertension (systolic pressure, ≥160 mm Hg; or diastolic pressure, ≥105 mm Hg) developed (control group). The 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. The safety outcome was small-for-gestational-age birth weight below the 10th percentile for gestational age. Secondary outcomes included composites of serious neonatal or maternal complications, preeclampsia, and preterm birth. RESULTS: A total of 2408 women were enrolled in the trial. The incidence of a primary-outcome event was lower in the active-treatment group than in the control group (30.2% vs. 37.0%), for an adjusted risk ratio of 0.82 (95% confidence interval [CI], 0.74 to 0.92; P<0.001). The percentage of small-for-gestational-age birth weights below the 10th percentile was 11.2% in the active-treatment group and 10.4% in the control group (adjusted risk ratio, 1.04; 95% CI, 0.82 to 1.31; P = 0.76). The incidence of serious maternal complications was 2.1% and 2.8%, respectively (risk ratio, 0.75; 95% CI, 0.45 to 1.26), and the incidence of severe neonatal complications was 2.0% and 2.6% (risk ratio, 0.77; 95% CI, 0.45 to 1.30). The incidence of any preeclampsia in the two groups was 24.4% and 31.1%, respectively (risk ratio, 0.79; 95% CI, 0.69 to 0.89), and the incidence of preterm birth was 27.5% and 31.4% (risk ratio, 0.87; 95% CI, 0.77 to 0.99). CONCLUSIONS: In pregnant women with mild chronic hypertension, a strategy of targeting a blood pressure of less than 140/90 mm Hg was associated with better pregnancy outcomes than a strategy of reserving treatment only for severe hypertension, with no increase in the risk of small-for-gestational-age birth weight. (Funded by the National Heart, Lung, and Blood Institute; CHAP ClinicalTrials.gov number, NCT02299414.)."}