Tablets or “Injections” for severe hypertension in pregnancy?

We will discuss “Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: a systematic review” by the Community Level Interventions for Pre-eclampsia (CLIP) Working Group from 27 August 2014 for 7 days.

*This paper has been made open-access by the authors. Its accompanying mini-commentary by ME Norton will be made free-to-view on 18 August 2014.

Start date: 27 August 2014 (the discussion will open for 7 days)

First hosted discussion session(s) starts at: BST 7pm (UK time)

Host: @BlueJCHost

Platforms: Twitter

The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of each month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (data S1).

The discussion points are attached below (quoted from the published manuscript)

Scenario

An asymptomatic patient is admitted to the high dependency unit of the labour ward with severe postpartum gestational hypertension. Her blood pressure (BP) is poorly controlled (systolic 168 mmHg/diastolic 112 mmHg). Following a decision concerning her management, she requests oral antihypertensive therapy. She asks: ‘is medication through the drip really better?’

 Description of research

Participants Severe hypertension (systolic BP ≥160 mmHg/diastolic BP ≥110 mmHg) in any hypertensive disorder in pregnancy
Intervention Oral antihypertensive therapy
Comparison Antihypertensive therapy (any route), placebo or no treatment
Outcomes Primary outcome: treatment success (achievement of target BP occurring within 24 hour of treatment)Secondary outcomes: Maternal and perinatal outcomes
Study design Systematic review of randomised controlled trials

Discussion Points

  • What is the definition of severe hypertension?
  • Which study characteristics are assessed when determining the risk of bias of included studies?
  • Which secondary outcomes would you consider most important and why?
  • What is the significance of the confidence intervals when considering the Forest plots in this study?
  • Can you briefly summarise the results of the summary? How would you advise the patient in this clinical situation?
  • What are the benefits of oral antihypertensive medication within resource-poor settings? (Data S1)

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.