Control of Hypertension in Pregnancy (CHIPS) will be an open, multicentre, international, randomised controlled trial with an intention-to -treat analysis. The study is pragmatic: it will be undertaken to reflect real clinical practice rather than the very tightly controlled circumstances of explanatory trials. The pragmatic approach is important in this trial, where the interventions are policies of ‘less tight’ and ‘tight’ control, and it is not possible to blind clinicians or patients to the dBP goals of each treatment group.
There is now solid evidence that a reduced rate of growth before birth is associated with adult cardiovascular disease (like heart attack or stroke). The information comes from different populations around the world, and is true even when babies are born with normal birth weights. At present, the ‘Developmental Origins Hypothesis’ provides the best explanation. In response to decreased nutrition in the uterus, changes are made to the activity of fetal genes (the ‘code’ that determines our health and traits like height).