{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T01:01:41Z","timestamp":1791594101671,"version":"4.3.4"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T00:00:00Z","timestamp":1677110400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>In the United States, there has been controversy over whether treatment of mild\u2010to\u2010moderate hypertension during pregnancy conveys more benefit than risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective of the study was to compare risks and benefits of treatment of mild\u2010to\u2010moderate hypertension during pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study included 11,871 pregnant women with mild\u2010to\u2010moderate hypertension as defined by blood pressure (BP) values from three Kaiser Permanente regions between 2005 and 2014. Data were extracted from electronic health records. Dynamic marginal structural models with inverse probability weighting and informative censoring were used to compare risks of adverse outcomes when beginning antihypertensive medication treatment at four BP thresholds (\u2265155\/105, \u2265150\/100, \u2265145\/95, \u2265140\/90\u2009mm\u2009Hg) compared with the recommended threshold in the United States at that time, \u2265160\/110\u2009mm\u2009Hg. Outcomes included preeclampsia, preterm birth, small\u2010for\u2010gestational\u2010age (SGA), Neonatal Intensive Care Unit (NICU) care, and stillbirth. Primary analyses allowed 2\u2009weeks for medication initiation after an elevated BP. Several sensitivity and subgroup (i.e., race\/ethnicity and pre\u2010pregnancy body mass index) analyses were also conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In primary analyses, medication initiation at lower BP thresholds was associated with greater risk of most outcomes. Comparing the lowest (\u2265140\/90\u2009mm\u2009Hg) to the highest BP threshold (\u2265160\/110\u2009mm\u2009Hg), we found an excess risk of preeclampsia (adjusted Risk Difference (aRD) 38.6 per 100 births, 95% Confidence Interval (CI): 30.6, 46.6), SGA (aRD: 10.2 per 100 births, 95% CI: 2.6, 17.8), NICU admission (aRD: 20.2 per 100 births, 95% CI: 12.6, 27.9), and stillbirth (1.18 per 100 births, 95% CI: 0.27, 2.09). The findings did not reach statistical significance for preterm birth (aRD: 2.5 per 100 births, 95% CI: \u22120.4, 5.3). These relationships were attenuated and did not always reach statistically significance when comparing higher BP treatment thresholds to the highest threshold (i.e., \u2265160\/110\u2009mm\u2009Hg). Sensitivity and subgroup analyses produced similar results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Initiation of antihypertensive medication at mild\u2010to\u2010moderate BP thresholds (140\u2013155\/90\u2013105\u2009mm\u2009Hg; with the largest risk consistently associated with treatment at 140\/90\u2009mm\u2009Hg) may be associated with adverse maternal and neonatal outcomes. Limitations include inability to measure medication adherence.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2778","type":"journal-article","created":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T09:49:25Z","timestamp":1676281765000},"page":"381-390","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Maternal and neonatal outcomes associated with treating hypertension in pregnancy at different thresholds"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8748-0614","authenticated-orcid":false,"given":"Lyndsay A.","family":"Avalos","sequence":"first","affiliation":[{"name":"Kaiser Permanente Northern California Division of Research  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain S.","family":"Neugebauer","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California Division of Research  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nerissa","family":"Nance","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California Division of Research  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia E.","family":"Badon","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California Division of Research  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. Craig","family":"Cheetham","sequence":"additional","affiliation":[{"name":"Chapman University  Irvine California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas R.","family":"Easterling","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristi","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Southern California Department of Research and Evaluation  California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abisola","family":"Idu","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe","family":"Bider\u2010Canfield","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Southern California Department of Research and Evaluation  California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria L.","family":"Holt","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"Dublin","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute  Seattle Washington USA"},{"name":"Department of Epidemiology University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,2,23]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7117a1"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.preghy.2018.05.004"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYP.0000000000000208"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.117.10803"},{"key":"e_1_2_9_6_1","volume-title":"Hypertension in Pregnancy: Diagnosis and Management","author":"National Institute for Health and Care Excellence","year":"2019"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1701-2163(15)30588-0"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2020.02.086"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/aog.0000000000003891"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002252.pub4"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2201295"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1404595"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwv254"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.2202\/1557-4679.1212"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3301"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3627"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-3-6"},{"key":"e_1_2_9_18_1","unstructured":"LeongTK TabadaGH YangJ ZhuZ NeugebauerRS.Msmstructure. 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