In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released new guidelines for the evaluation of high blood pressure (BP). These lowered definitions for hypertension include: normal (<120/80 mmHg), elevated (120-129/<80 mmHg), stage 1 (130-139/80-89 mmHg), and stage 2 hypertension (≥140/90). Conversely, ACOG defines chronic hypertension as the presence of systolic BP≥140 mmHg or diastolic BP≥90 mmHg on ≥2 occasions before 20 weeks’ gestation.
There is limited data on the impact of hypertension as defined by the ACC/AHA in pregnancy. We aim to determine if there is a relationship between elevated or stage 1 hypertension in the first trimester and pregnancy-induced hypertensive disorders (PIH).
In this IRB approved retrospective cohort study, we examined singleton pregnancies, registered in the first trimester and diagnosed with PIH (gestational hypertension, preeclampsia +/- severe features, and HELLP) at an urban hospital between March and September 2018.
110 patients were included: 61.8% of the study population had elevated (22.7%) or stage 1 (39.1%) hypertension. The mean age was greater in normotensive patients(p=0.03). Otherwise, demographics, gestational age(p=0.27), and timing of delivery(p=0.41) were similar between hypertension groups. Neither the incidence of PIH nor the specific PIH diagnosis were associated with hypertension status in the first trimester(p=0.08).
Our data suggests no association between ACC/AHA hypertension status in the first trimester and PIH. However, over 60% of patients would be classified as early/stage I hypertension. Therefore, further evaluation of the incidence of ACC/AHA hypertension in patients with/without PIH and comparison to ACOG criteria is warranted.