Epidemiology and Mechanisms of De Novo and Persistent Hypertension in the Postpartum Period.
Epidemiology and Mechanisms of De Novo and Persistent Hypertension in the Postpartum Period.
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在产后时期，从头和持续性高血压的流行病学和机制。
DOI：
10.1161/circulationaha.115.015721
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发表时间：
2015-11-03
期刊：
影响因子：
37.8
通讯作者：
Rana S
中科院分区：
文献类型：
--
作者：
Goel A;Maski MR;Bajracharya S;Wenger JB;Zhang D;Salahuddin S;Shahul SS;Thadhani R;Seely EW;Karumanchi SA;Rana S
产后即刻高血压的病理生理机制尚不清楚。我们研究了连续988名因单胎妊娠剖宫产而进入三级医疗中心的妇女。检测与子痫前期相关的血管生成因子--可溶性FMS样酪氨酸激酶1(SFlt1)和胎盘生长因子(PlGF)。然后我们进行了多变量分析，以确定与产后高血压风险相关的因素。在988名妇女中，184名妇女(18.6%)患上了产后高血压。在184名妇女中，有77名在产后患上新发高血压，其余的在产前有妊娠高血压疾病。高体重指数和糖尿病史与产后高血压的发生有关。产前sFlt1/PlGF比值与产后血压[产后最高收缩压(r=0.29P<；0.001)和舒张压(r=0.28P<；0.001)]呈正相关。多因素分析显示，产前sFlt1/PlGF比值最高与产后高血压独立相关[OR：2.25(1.19，4.25)，P=0.01；持续性高血压组：2.61(1.12，6.05)；P=0.02]。与血压正常的妇女相比，患有产后高血压的妇女住院时间更长(6.5vs5.7±3.4d；P<；0.001)。产后高血压相对常见，并与住院时间延长有关。患有产后高血压的妇女有相似的临床危险因素，与先兆子痫妇女的产前血浆血管生成谱相似。这些数据表明，产后高血压可能代表了一组亚临床或未解决的先兆子痫。
The pathophysiology of hypertension in the immediate postpartum period is unclear. We studied 988 consecutive women admitted to a tertiary medical center for cesarean section of a singleton pregnancy. Angiogenic factors, soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF), both biomarkers associated with preeclampsia, were measured on antepartum blood samples. We then performed multivariable analyses to determine factors associated with the risk of developing postpartum hypertension. Of the 988 women, 184 women (18.6%) developed postpartum hypertension. 77 out of 184 women developed de novo hypertension in the postpartum period and the remainder had a hypertensive disorder of pregnancy in the antepartum period. A higher body mass index and history of diabetes mellitus were associated with development of postpartum hypertension. The antepartum sFlt1/PlGF ratio positively correlated with blood pressures in the postpartum period [highest postpartum systolic (r=0.29; P<0.001) and diastolic (r=0.28, P<0.001)]. Moreover, the highest tertile of the antepartum sFlt1/PlGF ratio was independently associated with postpartum hypertension [OR: 2.25 (1.19, 4.25), P=0.01 in the de novo hypertensive group and 2.61 (1.12, 6.05) in the persistent hypertensive group; P=0.02] in multivariable analysis. Women developing postpartum hypertension had longer hospitalization than those who remained normotensive (6.5 ± 3.5 versus 5.7 ± 3.4 days; P<0.001). Hypertension in the postpartum period is relatively common and is associated with prolonged hospitalization. Women with postpartum hypertension share similar clinical risk factors as well as a similar antepartum plasma angiogenic profile found in women with preeclampsia. These data suggest that postpartum hypertension may represent a group of women with subclinical or unresolved preeclampsia.