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Until 2022, optimal management of mild hypertension in pregnancy has been unclear. The American College of Obstetrics and Gynecology (ACOG) guidelines favored a blood pressure (BP) threshold of 160/110 mm Hg for initiating antihypertensive treatment, because lowering maternal BP hadn't been clearly shown to improve pregnancy outcomes. In addition, concerns existed about the effect on fetal growth of reducing uteroplacental blood flow.
In the Chronic Hypertension and Pregnancy (CHAP) trial, 2400 pregnant women with mild hypertension (at <23 weeks' gestation) were randomized either to receive antihypertensive medication if BP exceeded 140/90 mm Hg or to be managed expectantly unless BP exceeded 160/105 mm Hg; nearly all drug-treated patients r…