{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,12,25]],"date-time":"2024-12-25T00:10:03Z","timestamp":1735085403308,"version":"3.32.0"},"reference-count":17,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>\n            Objective\u2003This study aimed to identify factors associated with refractory severe hypertension that does not resolve after an initial dose of antihypertensive medication in patients with preeclampsia.<\/jats:p><jats:p>\n            Study Design\u2003This was a retrospective study of all pregnant and postpartum individuals with a diagnosis of preeclampsia, superimposed preeclampsia, HELLP (hemolysis, elevated liver enzymes, low platelet) syndrome, or eclampsia who delivered at 22 weeks or greater at a single academic institution from 2010 to 2020. Inclusion criteria were patients with preeclampsia who developed severe hypertension (systolic pressure \u2265160\u2009mm Hg or diastolic pressure \u2265110\u2009mm Hg) and received antihypertensive medications for acute severe hypertension. We defined refractory severe hypertension as a systolic blood pressure of \u2265160\u2009mm Hg or a diastolic blood pressure of \u2265110\u2009mm Hg that did not improve after receiving the initial treatment. To evaluate for factors associated with refractory severe hypertension, we developed multivariable modified Poisson regression using all variables with p-value &lt;0.1 on bivariable analysis and calculated adjusted relative risks (aRRs) with 95% confidence intervals (95% CIs).<\/jats:p><jats:p>\n            Results\u2003Of 850, 386 (45.4%) had refractory severe hypertension and 464 (54.6%) responded to the initial antihypertensive medications. Factors associated with refractory severe hypertension included higher body mass index (BMI), chronic hypertension, and higher systolic pressure. Every 5\u2009kg\/m2 increase in BMI was associated with a 7% increased risk of refractory severe hypertension (aRR\u2009=\u20091.07; 95% CI: 1.02\u20131.12). Every 10\u2009mm Hg increase in systolic blood pressure was associated with a 10% increased risk of refractory severe hypertension (aRR\u2009=\u20091.10; 95% CI: 1.04\u20131.17). Chronic hypertension was associated with a 25% increased risk of refractory severe hypertension (aRR\u2009=\u20091.25; 95% CI: 1.01\u20131.56) in the diastolic pressure model.<\/jats:p><jats:p>\n            Conclusion\u2003Refractory severe hypertension was associated with elevated BMI, chronic hypertension, and higher systolic blood pressure.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-2330-1290","type":"journal-article","created":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T23:03:11Z","timestamp":1716246191000},"page":"100-107","source":"Crossref","is-referenced-by-count":0,"title":["Factors Associated with Refractory Severe Hypertension in Patients with Preeclampsia"],"prefix":"10.1055","volume":"42","author":[{"given":"Kari","family":"Flicker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maya","family":"Vishnia","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madeleine","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matilda","family":"Francis","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenyone S.","family":"King","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren","family":"Gilgannon","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neha","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aref","family":"Rastegar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohini Kousalya","family":"Siva","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lea","family":"Nehme","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Saade","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baha M.","family":"Sibai","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, The University of Texas Health Science Center, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tetsuya","family":"Kawakita","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,6,21]]},"reference":[{"issue":"07","key":"ref1","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1161\/CIRCRESAHA.118.313276","article-title":"Preeclampsia: pathophysiology, challenges, and perspectives","volume":"124","author":"S Rana","year":"2019","journal-title":"Circ Res"},{"issue":"17","key":"ref2","doi-asserted-by":"crossref","first-page":"585","DOI":"10.15585\/mmwr.mm7117a1","article-title":"Hypertensive disorders in pregnancy and mortality at delivery hospitalization - United States, 2017-2019","volume":"71","author":"N D Ford","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1097\/AOG.0000000000000746","article-title":"Pregnancy-related mortality in California: causes, characteristics, and improvement opportunities","volume":"125","author":"E K Main","year":"2015","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1212\/01.wnl.0000228277.84760.a2","article-title":"Intracerebral hemorrhage in pregnancy: frequency, risk factors, and outcome","volume":"67","author":"B T Bateman","year":"2006","journal-title":"Neurology"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.ejogrb.2013.09.021","article-title":"Maternal death from stroke: a thirty year national retrospective review","volume":"171","author":"L Foo","year":"2013","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"01","key":"ref7","first-page":"1","article-title":"ACOG Practice Bulletin No. 202: Gestational hypertension and preeclampsia","volume":"133","author":"American College of Obstetricians and Gynecologists","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"e90","DOI":"10.1097\/AOG.0000000000002019","article-title":"Committee Opinion, Number 692: Emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period","volume":"129","author":"Committee on Obstetric Practice","year":"2017","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"B2","DOI":"10.1016\/j.ajog.2021.10.007","article-title":"Society for Maternal-Fetal Medicine Special Statement: a quality metric for evaluating timely treatment of severe hypertension","volume":"226","author":"C A Combs","year":"2022","journal-title":"Am J Obstet Gynecol"},{"issue":"11","key":"ref10","doi-asserted-by":"crossref","first-page":"825","DOI":"10.7326\/0003-4819-158-11-201306040-00007","article-title":"Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline","volume":"158","author":"P E Stevens","year":"2013","journal-title":"Ann Intern Med"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1056\/NEJMoa1404595","article-title":"Less-tight versus tight control of hypertension in pregnancy","volume":"372","author":"L A Magee","year":"2015","journal-title":"N Engl J Med"},{"issue":"10","key":"ref12","first-page":"CD002252","article-title":"Antihypertensive drug therapy for mild to moderate hypertension during pregnancy","volume":"10","author":"E Abalos","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"issue":"05","key":"ref13","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1161\/HYPERTENSIONAHA.116.07862","article-title":"The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): is severe hypertension just an elevated blood pressure?","volume":"68","author":"L A Magee","year":"2016","journal-title":"Hypertension"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1097\/01.AOG.0000151116.84113.56","article-title":"Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure","volume":"105","author":"J N Martin Jr","year":"2005","journal-title":"Obstet Gynecol"},{"key":"ref15","first-page":"328","article-title":"A comparative trial of labetalol and hydralazine in the acute management of severe hypertension complicating pregnancy","volume":"70","author":"W C Mabie","year":"1987","journal-title":"Obstet Gynecol"},{"issue":"10","key":"ref16","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1111\/j.1471-0528.1993.tb15120.x","article-title":"Severe hypotension and fetal distress following sublingual administration of nifedipine to a patient with severe pregnancy induced hypertension at 33 weeks","volume":"100","author":"L Impey","year":"1993","journal-title":"Br J Obstet Gynaecol"},{"issue":"04","key":"ref17","first-page":"192","article-title":"The effect of nifedipine on fetal umbilical artery Doppler waveforms in pregnancies complicated by hypertension","volume":"79","author":"M S Puzey","year":"1991","journal-title":"S Afr Med J"},{"issue":"02","key":"ref18","doi-asserted-by":"crossref","first-page":"100809","DOI":"10.1016\/j.ajogmf.2022.100809","article-title":"Timely treatment of severe hypertension and risk of severe maternal morbidity at an urban hospital","volume":"5","author":"D M Vuncannon","year":"2023","journal-title":"Am J Obstet Gynecol MFM"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2330-1290.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T23:32:18Z","timestamp":1735083138000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2330-1290"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,20]]},"references-count":17,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2024,12,24]]},"published-print":{"date-parts":[[2025,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2330-1290","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"type":"print","value":"0735-1631"},{"type":"electronic","value":"1098-8785"}],"subject":[],"published-other":{"date-parts":[[2024,5,20]]},"published":{"date-parts":[[2024,5,20]]}}}