Effects of Antihypertensive Therapy During Pregnancy on Postpartum Blood Pressure Control.,Obstetrics and Gynecology

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Effects of Antihypertensive Therapy During Pregnancy on Postpartum Blood Pressure Control.
Obstetrics and Gynecology ( IF 5.7 ) Pub Date : 2024-10-01 , DOI: 10.1097/aog.0000000000005715
Samantha L Martin ₁ , Hui-Chien Kuo , Kim Boggess , Lorraine Dugoff , Baha Sibai , Kirsten Lawrence , Brenna L Hughes , Joseph Bell , Kjersti Aagaard , Kelly S Gibson , David M Haas , Lauren Plante , Torri D Metz , Brian M Casey , Sean Esplin , Sherri Longo , Matthew Hoffman , George R Saade , Janelle Foroutan , Methodius G Tuuli , Michelle Y Owens , Hyagriv N Simhan , Heather A Frey , Todd Rosen , Anna Palatnik , Susan Baker , Phyllis August , Uma M Reddy , Wendy Kinzler , Emily J Su , Iris Krishna , Nicki Nguyen , Mary E Norton , Daniel Skupski , Yasser Y El-Sayed , Dotun Ogunyemi , Zorina S Galis , Namasivayam Ambalavanan , Suzanne Oparil , Ronald Librizzi , Leonardo Pereira , Everett F Magann , Mounira Habli , Shauna Williams , Giancarlo Mari , Gabriella Pridjian , David S McKenna , Marc Parrish , Eugene Chang , Sarah Osmundson , JoAnne Quinones , Erika Werner , Jeff M Szychowski , Alan T N Tita ,

Affiliation

Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, University of Pennsylvania, Philadelphia, Pennsylvania, University of Texas at Houston, Houston, Texas, Columbia University, New York, New York, Duke University, Durham, North Carolina, St. Luke's University Health Network, Bethlehem, Pennsylvania, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, Metro Health/Case Western University, Cleveland, Ohio, Indiana University, Indianapolis, Indiana, Drexel University College of Medicine, Philadelphia, Pennsylvania, University of Utah Health, Salt Lake City, Utah, University of Texas Southwestern, Dallas, Texas, Intermountain Healthcare, Salt Lake City, Utah, Ochsner Health, New Orleans, Louisiana, University of Texas Medical Branch, Galveston, Texas, St. Peters University Hospital, New Brunswick, New Jersey, Washington University in St. Louis, St. Louis, Missouri, University of Mississippi Medical Center, Jackson, Mississippi, Magee Women's Hospital and University of Pittsburgh, Pittsburgh, Pennsylvania, The Ohio State University, Columbus, Ohio, Rutgers University-Robert Wood Johnson Medical School, Brunswick, New Jersey, Medical College of Wisconsin, Milwaukee, Wisconsin, University of South Alabama at Mobile, Mobile, Alabama, Weill Cornell University, New York City, New York, Yale University, New Haven, Connecticut, NYU Langone Hospital-Long Island, Mineola, New York, University of Colorado, Aurora, Colorado, Emory University, Atlanta, Georgia, Denver Health, Denver, Colorado, University of California, San Francisco, San Francisco, California, NewYork-Presbyterian Queens Hospital, Flushing, New York, Stanford University, Stanford, California, Arrowhead Regional Medical Center, Colton, California, Tulane University, New Orleans, Louisiana, Wright State University and Miami Valley Hospital, Dayton, Ohio, University of Kansas Medical Center, Kansas City, Kansas, Medical University of South Carolina, Charleston, South Carolina, Vanderbilt University School of Medicine, Nashville, Tennessee, and Tufts University School of Medicine, Boston, Massachusetts; Beaumont Hospital, Grand Rapids, Michigan; the Center for Women's Reproductive Health, the Department of Biostatistics, the Department of Pediatrics, and the Department of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama; the Christiana Care Center for Women's and Children Health Research, Newark, Delaware; Zuckerberg San Francisco General Hospital, San Francisco, California; the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland; Virtua Health, Marlton, New Jersey; Oregon Health and Science University, Portland, Oregon; the Department of Obstetrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; the Fetal Care Center of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, Ohio; the Department of Obstetrics, Gynecology and Women's Health, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey; Obstetrics and Gynecology/Maternal-Fetal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, Pennsylvania; and Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.

OBJECTIVE To compare differences in postpartum blood pressure (BP) control (BP below 140/90 mm Hg) for participants with hypertension randomized to receive antihypertensive treatment compared with no treatment during pregnancy. METHODS This study was a planned secondary analysis of a multicenter, open-label, randomized controlled trial (The CHAP [Chronic Hypertension and Pregnancy] trial). Pregnant participants with mild chronic hypertension (BP below 160/105 mm Hg) were randomized into two groups: active (antihypertensive treatment) or control (no treatment unless severe hypertension, BP 160/105 mm Hg or higher). Study outcomes were BP control below 140/90 mm Hg (primary) and medication nonadherence based on a composite score threshold (secondary) at the 6-week postpartum follow-up visit. Participants without follow-up BP measurements were excluded from analysis of the BP control outcome. Participants without health care professional-prescribed antihypertensives at delivery were excluded from the analysis of the adherence outcome. Multivariable logistic regression was used to adjust for potential confounders. RESULTS Of 2,408 participants, 1,684 (864 active, 820 control) were included in the analysis. A greater percentage of participants in the active group achieved BP control (56.7% vs 51.5%; adjusted odds ratio [aOR] 1.22, 95% CI, 1.00-1.48) than in the control group. Postpartum antihypertensive prescription was higher in the active group (81.7% vs 58.4%, P <.001), and nonadherence did not differ significantly between groups (aOR 0.81, 95% CI, 0.64-1.03). CONCLUSION Antihypertensive treatment of mild chronic hypertension during pregnancy was associated with better BP control below 140/90 mm Hg in the immediate postpartum period.

中文翻译：

怀孕期间抗高血压治疗对产后血压控制的影响。

目的比较随机接受抗高血压治疗的高血压参与者与妊娠期未治疗的患者在产后血压（BP）控制（BP 低于 140/90 mm Hg）方面的差异。方法本研究是对一项多中心、开放标签、随机对照试验（CHAP [慢性高血压和妊娠] 试验）的计划二次分析。患有轻度慢性高血压（血压低于 160/105 毫米汞柱）的孕妇参与者被随机分为两组：积极组（抗高血压治疗）或对照组（除非严重高血压，血压 160/105 毫米汞柱或更高，否则不治疗）。研究结果是血压控制低于 140/90 毫米汞柱（原发性）和产后 6 周随访时基于综合评分阈值（继发性）的药物不依从性。没有随访血压测量的参与者被排除在血压控制结局分析之外。分娩时没有医疗保健专业人员开具的抗高血压药的参与者被排除在依从性结果分析之外。多变量 logistic 回归用于调整潜在的混杂因素。结果在 2,408 名参与者中，包括 1,684 名（864 名活性药物，820 名对照）被纳入分析。与对照组相比，活性组实现血压控制的参与者比例更高（56.7% vs 51.5%;调整比值比 [aOR] 1.22,95% CI，1.00-1.48）。活性组产后降压药处方较高（81.7% vs 58.4%，P <.001），组间依从性无显著差异（aOR 0.81,95% CI，0.64-1.03）。结论妊娠期轻度慢性高血压的降压治疗与产后即刻血压控制低于 140/90 mm Hg 的较好相关。

更新日期：2024-09-12

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