The Risk Factors That Predict Chronic Hypertension After Delivery in Women With a History of Hypertensive Disorders of Pregnancy.
The Risk Factors That Predict Chronic Hypertension After Delivery in Women With a History of Hypertensive Disorders of Pregnancy.
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DOI：
10.1097/md.0000000000001747
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发表时间：
2015-10
期刊：
影响因子：
1.6
通讯作者：
Kim DK
中科院分区：
文献类型：
--
作者：
Hwang JW;Park SJ;Oh SY;Chang SA;Lee SC;Park SW;Kim DK
妊娠期高血压疾病（HDP）是孕妇最重要的致命并发症之一。它也与慢性高血压的后续发展有关。本研究的目的是确定产后慢性高血压的临床危险因素诊断为HDP的妇女。600例确诊为HDP并在产后至少随访6个月的患者被纳入研究。根据产后慢性高血压的发生情况将纳入研究的对象分为2组：有慢性高血压的“病例组”（n = 41）和无慢性高血压的“对照组”（n = 559）。 评估了临床和人口统计学因素。通过多元回归分析，早发性高血压伴终末器官功能障碍、吸烟、孕前体重指数（BMI）较高、合并症、系统性红斑狼疮（SLE）或抗磷脂综合征（APLS）与产后期进展为慢性高血压相关。5个模型的曲线下面积（AUC）值从0.645增加到0.831，这表明改善了对慢性高血压进展的预测。额外的多变量分析显示了显著的特定风险因素。这项回顾性的单医院研究表明，临床危险因素，即早发性高血压伴终末器官功能障碍，吸烟，孕前BMI较高，是分娩后女性慢性高血压的重要独立预测因素。风险因素的识别使我们能够缩小产后高血压监测和管理的主题领域。
Hypertensive disorders of pregnancy (HDP) is one of the most important lethal complications in pregnant mothers. It is also associated with the subsequent development of chronic hypertension. The objective of this study was to identify the clinical risk factors of postpartum chronic hypertension in women diagnosed with HDP. Six hundred patients as HDP, who diagnosed and followed-up at least 6 month after delivery, were included in the study. We divided the included subjects in 2 groups based on the development of postpartum chronic hypertension: presenting with the chronic hypertension, “case group” (n = 41) and without chronic hypertension, “control group” (n = 559). Clinical and demographic factors were evaluated. By multiple regression analysis, early onset hypertension with end-organ dysfunction, smoking, higher prepregnancy body mass index (BMI), and comorbidities, systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APLS), were associated with progression to chronic hypertension in the postpartum period. The value of area under the curves (AUC) for the 5 models, that generated to combine the significant factors, increased from 0.645 to 0.831, which indicated improved prediction of progression to the chronic hypertension. Additional multivariate analysis revealed significant specific risk factors. This retrospective single hospital-based study demonstrated that the clinical risk factors, that is early onset hypertension with end-organ dysfunction, smoking, and higher prepregnancy BMI, were significant independent predictors of chronic hypertension in women after delivery. Identification of risk factors allowed us to narrow the subject field for monitoring and managing high blood pressure in the postpartum period.