Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy: nationwide cohort study.
Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy: nationwide cohort study.
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DOI：
10.1136/bmj.j3078
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发表时间：
2017-07-12
期刊：
影响因子：
--
通讯作者：
Boyd HA
中科院分区：
文献类型：
--
作者：
Behrens I;Basit S;Melbye M;Lykke JA;Wohlfahrt J;Bundgaard H;Thilaganathan B;Boyd HA
目的探讨妊娠期高血压疾病患者分娩后多长时间患妊娠后高血压的风险增加，以及这种风险是如何随时间演变的。设计：基于全国登记册的队列研究。背景是丹麦。1995年至2012年间第一次活产或死产的初产妇女482 972人(累积发病率分析)，1978年至2012年至少一次活产或死胎的1 025 118人(COX回归分析)。主要观察指标为需要处方药治疗的妊娠后高血压的10年累积发病率，以及用COX回归估计的风险比。结果在20多岁首次妊娠合并高血压疾病的妇女中，14%的人在产后第一个十年患高血压，而血压正常的妇女在20多岁时患高血压的比例为4%。在40多岁首次怀孕的女性中，相应的比例分别为32%和11%。在产后一年，患有妊娠高血压疾病的妇女患高血压的几率是正常妊娠妇女的12到25倍。患有妊娠期高血压疾病的妇女在产后1-10年的发病率高出三到十倍，即使在产后20年或更长时间后仍保持着两倍的高水平。结论：妊娠期高血压疾病合并高血压的风险在妊娠后即刻很高，并持续20年以上。多达三分之一患有妊娠高血压疾病的妇女可能在受影响的怀孕十年内患上高血压，这表明这些妇女的心血管疾病预防应该包括在怀孕后不久开始进行血压监测。
Objectives To determine how soon after delivery the risk of post-pregnancy hypertension increases in women with hypertensive disorders of pregnancy and how the risk evolves over time. Design Nationwide register based cohort study. Setting Denmark. Populations 482 972 primiparous women with a first live birth or stillbirth between 1995 and 2012 (cumulative incidence analyses), and 1 025 118 women with at least one live birth or stillbirth between 1978 and 2012 (Cox regression analyses). Main outcome measures 10 year cumulative incidences of post-pregnancy hypertension requiring treatment with prescription drugs, and hazard ratios estimated using Cox regression. Results Of women with a hypertensive disorder of pregnancy in a first pregnancy in their 20s, 14% developed hypertension in the first decade post partum, compared with 4% of women with normotensive first pregnancies in their 20s. The corresponding percentages for women with a first pregnancy in their 40s were 32% and 11%, respectively. In the year after delivery, women with a hypertensive disorder of pregnancy had 12-fold to 25-fold higher rates of hypertension than did women with a normotensive pregnancy. Rates in women with a hypertensive disorder of pregnancy were threefold to 10-fold higher 1-10 years post partum and remained twice as high even 20 or more years later. Conclusions The risk of hypertension associated with hypertensive disorders of pregnancy is high immediately after an affected pregnancy and persists for more than 20 years. Up to one third of women with a hypertensive disorder of pregnancy may develop hypertension within a decade of an affected pregnancy, indicating that cardiovascular disease prevention in these women should include blood pressure monitoring initiated soon after pregnancy.
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DOI：
10.1161/hypertensionaha.116.07099
发表时间：
2016-06
期刊：
Hypertension (Dallas, Tex. : 1979)
影响因子：
--
作者：
Egeland GM;Klungsøyr K;Øyen N;Tell GS;Næss Ø;Skjærven R
通讯作者：
Skjærven R
影响因子：
8.3
作者：
Lykke, Jacob A.;Langhoff-Roos, Jens;Paidas, Michael J.
通讯作者：
Paidas, Michael J.
影响因子：
7.2
作者：
Wilkins-Haug, Louise;Celi, Ann;Seely, Ellen W.
通讯作者：
Seely, Ellen W.
影响因子：
37.8
作者：
Romundstad, Pal R.;Magnussen, Elisabeth B.;Vatten, Lars J.
通讯作者：
Vatten, Lars J.
影响因子：
7.2
作者：
Magnussen, Elisabeth B.;Vatten, Lars J.;Romundstad, Pal R.
通讯作者：
Romundstad, Pal R.