ArticleBMJ medicine2026
Modelling lowering of raised blood pressure in pregnancy to reduce pre-eclampsia: secondary analysis of data from prospective cohort studies.
Article in BMJ medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To determine whether antihypertensive treatment of blood pressure levels of <140/90 mm Hg can reduce the incidence of pre-eclampsia. Design: Secondary analysis of data from prospective cohort studies. Setting: Three prospective screening studies of women who attended routine hospital maternity visits at 11-13 weeks' gestation, 1 February 2010 to 31 December 2016. Participants were from seven secondary care institutions in England. Participants: 54 422 pregnancies screened at 11-13 weeks' gestation for pre-eclampsia and with blood pressure values available, that resulted in a liveborn or stillborn infant at ≥24 weeks' gestation. Main outcome measures: Incidence of pre-eclampsia (overall, and at preterm or term gestational ages), according to modelled blood pressure lowering. Results: The study population was ethnically diverse (17.3% black participants, 7.8% from South or East Asia, and 2.6% self-identified with more than one ethnic group). The Fetal Medicine Foundation competing risks model was used to calculate the expected risk of pre-eclampsia, based on maternal characteristics, mean arterial pressure, uterine artery pulsatility index, and placental growth factor. The expected risk of pre-eclampsia was used to calculate the expected incidence of pre-eclampsia. Reducing diastolic blood pressure from >85 mm Hg to a target of 85 mm Hg would mean that 4.8% of women would be offered antihypertensive drugs, with a potential relative risk reduction of 21.4% (absolute reduction of 2.9%) in any pre-eclampsia and 28.3% (absolute reduction of 1.4%) reduction in preterm pre-eclampsia. By reducing diastolic blood pressure from >80 mm Hg to a target of 80 mm Hg, 13.2% of women would receive antihypertensive drugs, with a potential relative risk reduction of 26.0% (absolute reduction of 2.3%) in any pre-eclampsia and 33.8% (absolute reduction of 1.0%) reduction in preterm pre-eclampsia. By reducing diastolic blood pressure from >75 mm Hg to a target of 75 mm Hg, 29.5% of women would receive antihypertensive drugs, with a potential relative risk reduction of 32.8% (absolute reduction of 2.1%) in any pre-eclampsia and 41.6% (absolute reduction of 0.8%) in preterm pre-eclampsia. Conclusions: Lowering blood pressure from early pregnancy may reduce preterm and term pre-eclampsia. This finding requires evaluation in a definitive randomised trial.
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