Blood Pressure Treatment Goals for Preeclampsia

(GOALPOST Trial)

This trial explores optimal blood pressure management in pregnant individuals with gestational hypertension or mild preeclampsia. It examines whether using anti-hypertensive medication to maintain blood pressure below 140/90 mmHg results in better pregnancy outcomes compared to usual care, which initiates treatment only if blood pressure reaches 160/110 mmHg. Eligible participants should be between 23 and 35 weeks pregnant, carrying one baby or non-identical twins, and have a recent diagnosis of high blood pressure without severe symptoms. As a Phase 3 trial, this study represents the final step before FDA approval, offering participants an opportunity to contribute to significant advancements in pregnancy care.

If you are currently taking medication to lower blood pressure, you may need to stop for 48 hours before joining the trial. This is called a 'washout period' (time without taking certain medications).

Studies have shown that treating high blood pressure during pregnancy is generally safe. Research indicates that medications like labetalol and nifedipine, commonly used for this purpose, do not increase the risk of harmful effects for the mother or baby. Labetalol, for example, is often used and well-tolerated by many pregnant patients. Nifedipine, another option, has also proven safe during pregnancy, with no significant increase in negative outcomes reported.

Researchers are excited about this trial because it explores different blood pressure goals for managing preeclampsia, a condition that affects pregnant women. Unlike the usual care, which starts treatment when blood pressure reaches 160/110 mmHg, the experimental approach aims to keep blood pressure below 140/90 mmHg. This could potentially improve outcomes by reducing the risks associated with higher blood pressure levels earlier in the pregnancy. By investigating these different treatment goals, researchers hope to find a more effective strategy for managing preeclampsia and ultimately improve maternal and fetal health.

Research has shown that controlling blood pressure during pregnancy can improve health outcomes for both mother and baby. This trial will compare two approaches: one group will use anti-hypertensive medication titrated to a blood pressure goal of <140/90 mmHg, while the other will follow usual care with medication for blood pressure ≥160/110 mmHg, titrated to a goal of <160/110 mmHg. Studies have found that managing blood pressure with medication can lower the risk of preeclampsia, a condition characterized by high blood pressure. Specifically, one study found that actively managing blood pressure reduced the chance of serious pregnancy problems, such as severe preeclampsia, by 18%. Another study noted that certain medications, like labetalol, can reduce the risk of preeclampsia and early birth. Maintaining blood pressure below 140/90 mmHg is associated with fewer complications and better health outcomes for both mother and baby.²³⁴⁶⁷