Strict treatment of hypertension during pregnancy: Safe but not obviously better

The CHIPS (Control of Hypertension In Pregnancy Study) trial showed that tight blood pressure control in women with hypertension during pregnancy was safe with respect to neonatal outcome. However it was not linked to improvement of the predefined maternal composite outcome. The CHIPS trial is without doubt a landmark study in this field; however some questions are still unresolved. The study population consists of pregnant women with preexisting hypertension and those with gestational hypertension. As these groups differ regarding pathophysiology and are however covered in separate guidelines in the Netherlands. Unfortunately no subanalyses were performed for these groups. Moreover the primary neonatal endpoint is defined too broadly because of the inclusion of the rather vague component "higher than usual neonatal care". An endpoint combining major neonatal and maternal comorbidities would have been more clinically relevant. It is unlikely that the results of this trial will influence the Dutch guidelines.

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