Quality statement 3: Antenatal blood pressure targets

Quality statement

Women with hypertension in pregnancy have a blood pressure target set below 150/100 mmHg or, if they also have target organ damage, below 140/90 mmHg.

Rationale

Antihypertensive treatment should aim to lower blood pressure from the moderate or severe range, while avoiding excessive reductions that may affect fetal growth. It is recommended that women with evidence of target organ damage from hypertension will need a lower target blood pressure.

Quality measures

Structure

a) Evidence of local arrangements to ensure that pregnant women who have hypertension without target organ damage have a blood pressure target of below 150/100 mmHg.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that pregnant women who have hypertension and target organ damage have a blood pressure target of below 140/90 mmHg.

Data source: Local data collection.

Outcome

Rate of pregnant women with hypertension who maintain their target blood pressure throughout their pregnancy.

Data source: Local data collection.

What the quality statement means for service providers, healthcare practitioners and commissioners

Service providers ensure that there are local arrangements to set target blood pressures for pregnant women who have hypertension of below 150/100 mmHg, or below 140/90 mmHg if they have target organ damage, and to maintain blood pressures to these targets throughout pregnancy.

Healthcare practitioners set target blood pressures for pregnant women who have hypertension of below 150/100 mmHg, or below 140/90 mmHg if they have target organ damage, and ensure that these blood pressures are maintained throughout pregnancy.

Commissioners ensure they commission services that set target blood pressures for pregnant women who have hypertension of below 150/100 mmHg, or below 140/90 mmHg for women with target organ damage, and ensure that these blood pressures are maintained throughout pregnancy.

What the quality statement means for patients, service users and carers

Pregnant women with hypertension (high blood pressure) receive treatment aimed at keeping their blood pressure below 150/100 mmHg, or below 140/90 mmHg if their high blood pressure has led to problems with their eyes, heart or kidneys.

Source guidance

Definitions of terms used in this quality statement

Hypertension in pregnancy This definition includes chronic hypertension (present at the booking visit or before 20 weeks of pregnancy; this could include pre-existing hypertension), gestational hypertension (new hypertension presenting after 20 weeks without proteinuria) and pre-eclampsia (new hypertension presenting after 20 weeks with significant proteinuria [urinary protein:creatinine ratio greater than 30 mg/mmol or a validated 24‑hour urine collection result greater than 300 mg protein]).

Target organ damage Left ventricular hypertrophy, chronic kidney disease and hypertensive retinopathy are examples of target organ damage. See NICE clinical guideline 127 recommendation 1.2.6.