The CHIPS trial: Blood Pressure target in Pregnancy (www.cardiosage.com)

April 1, 2015 by  
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The CHIPS (Control of Hypertension in Pregnancy Study) compared less-tight control with tight control of hypertension in pregnancy.  While small clinical studies suggest that tight control of hypertension may be associated with maternal benefits it may cause perinatal risks such as poor fetal growth and reduced well-being.  The study included pregnant women at 14 weeks 0 days to 33 weeks 6 days of gestation with nonsevere, nonproteinuric preexisting hypertension or gestational hypertension with a diastolic blood pressure of 90 to 105 mm Hg if they were not receiving antihypertensive therapy, or 85 to 105 mm Hg if they were receiving therapy.  The authors reported no significant difference between the groups in the risk of pregnancy loss, high-level neonatal care, or overall maternal complications, although development of severe maternal hypertension was more frequent in the less-tight-control group.  (Magee LA, von Dadelszen P, Rey E, Ross S, Asztalos E, Murphy KE, Menzies J, Sanchez J, Singer J, Gafni A, Gruslin A, Helewa M, Hutton E, Lee SK, Lee T, Logan AG, Ganzevoort W, Welch R, Thornton JG, Moutquin JM. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med. 2015 Jan 29;372(5):407-17)

Dual Renin Angiotensin System Blockade

April 1, 2015 by  
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Two studies evaluated the effect of lisinopril combined with telmisartan in early and late stage polycystic kidney disease.  In late-stage polycystic kidney disease the rates of decline in the estimated GFR, urinary albumin excretion, and adverse events, including hyperkalemia and acute kidney injury, did not also differ significantly between two groups.  Similar conclusions were derived from another published study in which lisinopril and telmisartan were employed in early stage of autosomal dominant polycystic kidney disease.
(Torres VE, Abebe KZ, Chapman AB, Schrier RW, Braun WE, Steinman TI, Winklhofer FT, Brosnahan G, Czarnecki PG, Hogan MC, Miskulin DC, Rahbari-Oskoui FF, Grantham JJ, Harris PC, Flessner MF, Moore CG, Perrone RD; the HALT-PKD Trial Investigators. Angiotensin Blockade in Late Autosomal Dominant Polycystic Kidney Disease. N Engl J Med. 2014 Dec 11;371(24):2267-2276; Schrier RW, Abebe KZ, Perrone RD, Torres VE, Braun WE, Steinman TI, Winklhofer FT, Brosnahan G, Czarnecki PG, Hogan MC, Miskulin DC, Rahbari-Oskoui FF, Grantham JJ, Harris PC, Flessner MF, Bae KT, Moore CG, Chapman AB; the HALT-PKD Trial Investigators. Blood Pressure in Early Autosomal Dominant Polycystic Kidney Disease. N Engl J Med. 2014 Dec 11;371(24):2255-2266)