Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association.
Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association.
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DOI：
10.1161/hyp.0000000000000208
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发表时间：
2022-03
期刊：
影响因子：
8.3
通讯作者：
Chair, Vice
中科院分区：
文献类型：
--
作者：
Garovic, Vesna D.;Dechend, Ralf;Easterling, Thomas;Karumanchi, Ananth;Baird, Suzanne McMurtry;Magee, Laura A.;Rana, Sarosh;Vermunt, Jane V.;August, Phyllis;Chair, Vice
妊娠期高血压疾病（HDP）仍然是世界范围内与妊娠相关的孕产妇和胎儿发病率和死亡率的主要原因之一。受影响的女性在以后的生活中患心血管疾病（CVD）的风险也会增加，与传统的CVD风险无关。尽管有直接和长期的CVD风险，但在过去的几十年里，美国HDP的诊断和治疗建议几乎没有变化，如果有的话，与普通人群的高血压指南不同。这种方法的原因包括孕妇血压正常化治疗的益处问题，以及子宫胎盘灌注减少和子宫内暴露于抗高血压药物对胎儿健康的理论担忧。这份报告是基于对当前文献的回顾，包括：妊娠期可能影响HDP临床表现的正常生理变化; HDP流行病学及其即时和长期后遗症;先兆子痫的病理生理学，HDP通常与蛋白尿相关，并越来越多地被认为是一种具有不同临床表型和可能不同病理机制的异质性疾病;当前国家和国际HDP指南的关键概述;新出现的证据表明，降低妊娠期血压治疗目标可能会降低孕产妇重度高血压，而不会增加妊娠丢失、高水平新生儿护理或总体孕产妇并发症的风险;以及越来越多的人认识到与产后高血压/先兆子痫相关的发病率。最后，我们讨论了该领域研究的未来，以及迫切需要研究可能导致种族和民族孕产妇保健差异的社会经济和生物因素。
Hypertensive disorders of pregnancy (HDP) remain one of the major causes of pregnancy-related maternal and fetal morbidity and mortality worldwide. Affected women are also at increased risk for cardiovascular disease (CVD) later in life, independent of traditional CVD risks. Despite the immediate and long-term CVD risks, recommendations for diagnosis and treatment of HDP in the United States have changed little, if at all, over past decades, unlike hypertension guidelines for the general population. The reasons for this approach include the question of benefit from normalization of blood pressure treatment for pregnant women, coupled with theoretical concerns for fetal well-being from reduction in utero-placental perfusion and in utero exposure to antihypertensive medication. This report is based on a review of current literature and includes: normal physiological changes in pregnancy that may affect clinical presentation of HDP; HDP epidemiology and their immediate and long-term sequelae; the pathophysiology of preeclampsia, a HDP commonly associated with proteinuria and increasingly recognized as a heterogeneous disease with different clinical phenotypes and likely distinct pathological mechanisms; a critical overview of current national and international HDP guidelines; emerging evidence that reducing blood pressure treatment goals in pregnancy may reduce maternal severe hypertension without increasing the risk of pregnancy loss, high level neonatal care or overall maternal complications; and the increasingly recognized morbidity associated with postpartum hypertension/preeclampsia. Finally, we discuss the future of research in the field and the pressing need to study socioeconomic and biological factors that may contribute to racial and ethnic maternal health care disparities.