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Table 4 Diagnosis and treatment. Values are n (%) unless otherwise indicated

From: An evaluation of the influence of the publication of the UK National Institute for health and Care Excellence’s guidance on hypertension in pregnancy: a retrospective analysis of clinical practice

 

NICE hypertension in pregnancy recommendations

P-value1

P-value2 (CI)

Before guidance N = 1271

After guidance N = 1219

Gestational hypertension or pre-eclampsiaa

227 (18)

195 (16)

0.20

0.18 (− 0.05, 0.01)

Blood pressure equal or exceeding recommended treatment thresholdb

54 (24)

62 (32)

0.60

< 0.07 (− 0.17, 0.01)

Antihypertensive prescription (for gestational hypertension and Pre-eclampsia):

N = 227

N = 195

< 0.01

 

 No antihypertensive

139 (62)

53 (27)

< 0.01 (−0.44, − 0.26)

 Labetalol

58 (26)

120 (62)

< 0.01 (0.27, 0.45)

 Other antihypertensive prescribedc

28 (12)

22 (11)

0.75 (−0.07, 0.05)

 Missing

2 (< 1)

Protein estimated when hypertension identified

156 (68)

148 (76)

0.80

0.07 (−0.01, 0.17)

Method used to estimate protein:

N = 156

N = 148

< 0.01

 

 24 h urine

13 (8)

6 (4)

0.14 (−0.09, 0.01)

 Automated reagent strip reading

6 (4)

17 (11)

0.02 (0.01, 0.13)

 Spot PCR

47 (30)

98 (66)

< 0.01 (0.26, 0.46)

 Reagent strip visual inspection

67 (43)

26 (18)

 

 Other estimation

19 (12)

1 (< 1)

 Unclear

3 (2)

 Missing

1 (< 1)

Admitted due to HDP

92 (56)

127 (65)

< 0.01

< 0.001 (0.14, 0.33)

Care on hospital admission:

N = 92

N = 127

  

Highest mean systolic blood pressure prior to admission (for HDP)

150

155

< 0.01 (−9.3, −1.4)

Highest mean diastolic blood pressure prior to admission (for HDP)

98

114

0.19 (−40.7, 8.1)

Protein estimated prior to admission

67 (73)

92 (72)

0.70

0.87 (− 0.13, 0.11)

Anti-hypertensive prescribedc

46 (50)

79 (62)

0.02

0.08 (−0.01, 0.25)

Existing hypertensive medication increased

8 (9)

19 (15)

0.18 (−0.03, 0.15)

No medication prescribed or increased

36 (39)

29 (22)

0.01 (−0.29, 0.05)

Labetalol prescribed

35 (38)

64 (50)

0.07 (−0.01, 0.25)

Labetalol increased

5 (5)

21 (17)

0.01 (0.04, 0.20)

Other antihypertensive prescribedd

14 (15)

13 (10)

0.26 (−0.13, 0.04)

For all women with a HDP diagnosis:

N = 227

N = 195

  

Was early Birth < 37 weeks gestation offered due to HDP~

20 (9)

35 (18)

0.01

0.01 (0.02, 0.16)

If early Birth < 37 weeks gestation offered due to HDP:

N = 20

N = 35

0.20

 

 Was blood pressure ≥ 160/110

1 (5)

5 (14)

0.30 (−0.06, 0.24)

 No evidence of BP ≥ 160/110

9 (45)

8 (23)

0.09 (−0.48, 0.04)

  ‘Other’ concerns

10 (50)

22 (63)

0.35 (−0.14, 0.40)

For all women with a HDP diagnosis:

N = 227

N = 195

  

Was early Birth ≥ 37 weeks gestation offered due to HDP

68 (30)

103 (52)

< 0.01

< 0.01 (0.09, 0.35)

If early Birth ≥ 37 weeks gestation offered due to HDP:

N = 68

N = 103

< 0.01

 

 Blood pressure ≥ 160/110

8 (12)

5 (5)

0.10 (−0.16, 0.02)

 No evidence of BP ≥ 160/110

54 (79)

60 (58)

< 0.01 (−0.35, − 0.07)

  ‘Other’ concerns

6 (9)

38 (37)

< 0.01 (0.16, 0.40)

  1. 1difference in frequencies ‘before and after’ guidance publication
  2. 2difference in proportions ‘before and after’ guidance publication
  3. adiagnosis of gestational hypertension or pre-eclampsia or blood pressure equal to or greater than 140/90 on two occasions at least 4 h apart, this includes two readings at least 4 h apart with a systolic blood pressure equal to or greater than 140 with a normal diastolic or a diastolic equal to or greater than 90 with a normal systolic
  4. bBlood pressure greater than or equal to recommended treatment threshold 150/100 on two occasions at least 4 h apart
  5. cone or more drugs prescribed or increased
  6. dmethyldopa, nifedipine