Progression to Severe Chronic Hypertension 5-7 Years After a Pregnancy With Mild Chronic Hypertension.
Progression to Severe Chronic Hypertension 5-7 Years After a Pregnancy With Mild Chronic Hypertension.
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DOI：
10.1097/aog.0000000000004925
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发表时间：
2022-10-01
影响因子：
7.2
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中科院分区：
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评估妊娠合并轻度 cHTN 后 5-7 年内重度慢性高血压 (cHTN) 的发生率。这是一项回顾性队列研究，对象为 2012 年至 2014 年期间首次妊娠期间患有轻度 cHTN 的女性。如果女性在单一学术中心接受产前护理并且在怀孕期间患有轻度 cHTN，则她们将被纳入研究。排除患有严重 cHTN、1 型糖尿病、系统性红斑狼疮、心肌病、蛋白尿或基线妊娠 23 周前肌酐水平大于 1.1 mg/dL 的女性。主要结局是指数交付后 12 周以上的严重 cHTN（定义为新发两种或两种以上严重血压）或新发心血管疾病并发症的复合结果。共有 647 名患有轻度 cHTN 的女性符合纳入标准。其中，236 名（36.5%，95% CI 32.8-40.2%）女性在妊娠后 5-7 年内经历了严重 cHTN 的主要复合结局。黑人女性的进展速度比白人女性更快（调整后的风险比 [aHR] 1.99，95% CI 1.43–2.76）。吸烟还与更快速地进展为严重 cHTN 有关（aHR 1.47，95% CI 1.13-1.90）。在该队列中，三分之一在指数妊娠中患有轻度 cHTN 的女性在 5-7 年内进展为重度 cHTN。需要进行前瞻性研究来验证这一发现。
To estimate the incidence of severe chronic hypertension (cHTN) within 5–7 years after a pregnancy complicated by mild cHTN. This was a retrospective cohort study of women with mild cHTN during an index pregnancy between 2012 and 2014. Women were included if they received prenatal care at a single academic center and had mild cHTN during their pregnancy. Women with severe cHTN, type 1 diabetes, systemic lupus erythematosus, cardiomyopathy, proteinuria, or creatinine level greater than 1.1 mg/dL before 23 weeks of gestation at baseline were excluded. The primary outcome was a composite of severe cHTN (defined as new-onset of two or more severe blood pressures) or new-onset cardiovascular disease complications more than 12 weeks after the index delivery. A total of 647 women with mild cHTN met inclusion criteria. Of these, 236 (36.5%, 95% CI 32.8–40.2%) women experienced the primary composite outcome of severe cHTN within 5–7 years of the index pregnancy. Black women progressed more rapidly than White women (adjusted hazard ratio [aHR] 1.99, 95% CI 1.43–2.76). Smoking tobacco was also associated with more rapid progression to severe cHTN (aHR 1.47, 95% CI 1.13–1.90). In this cohort, one in three women with mild cHTN in an index pregnancy progressed to severe cHTN within 5–7 years. Prospective studies to validate this finding are needed.