Impact of Hypertensive Disorders of Pregnancy on the Risk of Stroke Stratified by Subtypes and Follow-Up Time.
Impact of Hypertensive Disorders of Pregnancy on the Risk of Stroke Stratified by Subtypes and Follow-Up Time.
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DOI：
10.1161/strokeaha.121.034109
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发表时间：
2022-03
期刊：
影响因子：
8.3
通讯作者：
Chiou WY
中科院分区：
文献类型：
--
作者：
Hung SK;Lee MS;Lin HY;Chen LC;Chuang CJ;Chew CH;Yu BH;Yang HJ;Hsu FC;Chiou WY
文本中提供了补充数字内容。妊娠期高血压疾病（HDP）包括4种亚型。以前的研究没有调查中风风险，不同HDP亚型和随访时间之间的关系，这是本研究的目的。回顾性分析了2000年至2017年台湾17 588名18至45岁有HDP病史的女性的数据。在与混杂因素匹配后，招募了13617名HDP女性和54468名非HDP女性。HDP女性卒中的校正风险比（aHR）为1.71（95%CI，1.46 - 2.00），缺血性和出血性卒中分别为1.60（1.35 - 1.89）和2.98（2.13 - 4.18）（所有P<0.001）。HDP组的总体卒中风险在分娩后10 - 15年仍为2.04倍（1.47 - 2.83，P<0.001）。虽然缺血性和出血性卒中的风险持续存在，但其风险时间趋势不同。缺血性卒中的风险在分娩后1 ~ 3年达到峰值，aHR为2.14（1.36-3.38），而出血性卒中的风险逐渐增加，在分娩后10 ~ 15年达到aHR为4.64（2.47 - 8.73）（均P<0.001）。在4种HDP亚型中，慢性高血压合并先兆子痫的卒中风险最高（aHR=3.86，1.91 - 7.82，P<0.001），其次为先兆子痫-子痫（aHR=2.00，1.63 - 2.45，P<0.001），和妊娠期高血压（aHR=1.68，1.13 - 2.52，P<0.05）;慢性既存高血压患者卒中风险最低（aHR=1.27，0.97 - 1.68，P>0.05）。此外，多重HDP合并先兆子痫的aHR为5.48（1.14−26.42，P<0.05）。HDP对未来卒中风险的影响持续长达17年，无论是缺血性卒中还是出血性卒中。多个HDP和先兆子痫的存在进一步增加中风的风险。
Supplemental Digital Content is available in the text. Hypertensive disorders of pregnancy (HDP) comprise 4 subtypes. Previous studies have not investigated the relationship between stroke risk, different HDP subtypes, and follow-up time, which was the purpose of this study. Data of 17 588 women aged 18 to 45 years who had a history of HDP in Taiwan from 2000 to 2017 was retrospectively reviewed. After matching with confounders, 13 617 HDP women and 54 468 non-HDP women were recruited. HDP women had an adjusted hazard ratio (aHR) of 1.71 (95% CI, 1.46−2.00) for stroke, and 1.60 (1.35−1.89) and 2.98 (2.13−4.18) for ischemic and hemorrhagic stroke, respectively (P<0.001 for all). The overall stroke risk in the HDP group was still 2.04 times 10 to 15 years after childbirth (1.47−2.83, P<0.001). Although the risks of both ischemic and hemorrhagic stroke persisted, their risk time trends were different. The risk of ischemic stroke reached peak during 1 to 3 years after childbirth with an aHR of 2.14 (1.36–3.38), while hemorrhagic stroke risk gradually increased and had an aHR of 4.64 (2.47−8.73) after 10 to 15 years of childbirth (both P<0.001). Among the 4 HDP subtypes, chronic hypertension with superimposed preeclampsia had the highest stroke risk (aHR=3.86, 1.91−7.82, P<0.001), followed by preeclampsia–eclampsia (aHR=2.00, 1.63−2.45, P<0.001), and gestational hypertension (aHR=1.68, 1.13−2.52, P<0.05); chronic preexisting hypertension had the lowest stroke risk (aHR=1.27, 0.97−1.68, P>0.05). Furthermore, multiple HDP combined with preeclampsia had aHR of 5.48 (1.14−26.42, P<0.05). The effect of HDP on the risk of future stroke persisted for up to 17 years, both for ischemic and hemorrhagic strokes. The presence of multiple HDP and preeclampsia further increase the stroke risk.