title: Is use of multiple antihypertensive agents to achieve blood pressure control associated with adverse pregnancy outcomes?
abstract: We assessed whether requiring >1 medication for blood pressure control is associated with adverse pregnancy outcomes.
  
  
  
  Retrospective cohort of 974 singletons with chronic hypertension at a tertiary care center. Subjects on >1 antihypertensive agent were compared with those on one agent <20 weeks gestational age with results stratified by average blood pressure (<140/90 and ⩾140/90 mm Hg) from prenatal visits. The primary maternal outcome was preeclampsia; the primary neonatal outcome was small for gestational age (<10th percentile).
  
  
  
  Among women with blood pressure ⩾140/90 mm Hg, women on multiple agents had the greatest risk of preeclampsia, severe preeclampsia, antenatal admissions to rule out preeclampsia, preterm birth <35 weeks and composite neonatal adverse outcomes.
  
  
  
  Compared with use of a single agent when blood pressure is ⩾140/90 mm Hg, use of multiple agents increases adverse risks, while no such finding exists when blood pressure is controlled below 140/90 mm Hg.
authors.affiliation: Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Allen
authors.affiliation: Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: A
authors.initials: A
authors.lastname: Tita
authors.affiliation: Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: S
authors.initials: S
authors.lastname: Anderson
authors.affiliation: Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Biggio
authors.affiliation: Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Dr L M
authors.initials: DLM
authors.lastname: Harper
mesh_terms: D000328:Adult; D000407:Alabama; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001794:Blood Pressure; D001795:Blood Pressure Determination; D002908:Chronic Disease; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D005865:Gestational Age; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy*; D007231:Infant, Newborn; D016015:Logistic Models; D015999:Multivariate Analysis; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000188:drug therapy; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D011295:Prenatal Care; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers
chemical_list: D000959:Antihypertensive Agents