The management of hypertension in women planning for pregnancy.
The management of hypertension in women planning for pregnancy.
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计划怀孕妇女的高血压管理
DOI：
10.1093/bmb/ldy035
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发表时间：
2018-12-01
影响因子：
6.7
通讯作者：
Yuan H
中科院分区：
文献类型：
--
作者：
Lu Y;Chen R;Cai J;Huang Z;Yuan H
摘要 引言或背景 妊娠早期高血压控制不佳会显着增加孕产妇和胎儿的发病率和死亡率。大多数指南和临床试验侧重于妊娠期和哺乳期高血压的管理和治疗，而可应用于妊娠前高血压管理的证据有限。在这篇综述中，我们总结了现有的孕前高血压治疗指南和治疗方法。 PubMed 数据来源。共识领域 甲基多巴和拉贝洛尔被认为是首选，但如果高血压女性希望怀孕，则需要停用血管紧张素转换酶 (ACE) 抑制剂和血管紧张素受体阻滞剂 (ARB)。对于患有慢性高血压的女性，在受孕前进行评估非常重要，以排除高血压的继发原因，评估其高血压控制以确保最佳状态，讨论先兆子痫的风险增加，并在怀孕前提供有关任何药物改变的教育。争议领域 关于不鼓励使用利尿剂的争论越来越多。关于钙、抗氧化剂和小剂量阿司匹林等补充剂的使用也存在争议。成长点 对于计划怀孕的高血压女性，可以设定限制较少的血压目标。怀孕前健康的体重可以降低患妊娠相关高血压疾病的风险。最近的指南还鼓励患有慢性高血压的女性通过在怀孕前减少或替代钠盐来保持低钠饮食摄入量。及时开展研究的领域 应进行大型、世界范围内的随机试验，以了解怀孕前服用抗氧化剂/体育活动的高血压女性的结果。
Abstract Introduction or background Poorly-controlled hypertension in the first trimester significantly increases maternal and fetal morbidity and mortality. The majority of guidelines and clinical trials focus on the management and treatments for hypertension during pregnancy and breast-feeding, while limited evidence could be applied to the management for hypertension before pregnancy. In this review, we summarized the existing guidelines and treatments of pre-pregnancy treatment of hypertension. Sources of data PubMed. Areas of agreement Methyldopa and labetalol are considered the first choice, but angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) need to be withdrawn if a hypertensive woman wishes to become pregnant. In women with chronic hypertension, it is very important to make an assessment before conception to exclude secondary causes of hypertension, evaluate their hypertensive control to ensure that it is optimal, discuss the increased risks of pre-eclampsia, and provide education regarding any drug alterations before they become pregnant. Areas of controversy There is increasing debate regarding discouraging the use of diuretics. There is also controversy regarding the use of supplementations such as calcium, antioxidants and low-dose aspirin. Growing points A less restricted blood-pressure goal could be set for hypertensive women planning for pregnancy. A healthy body weight before pregnancy could lower the risk of pregnancy-related hypertensive disorders. Recent guidelines also encourage women with chronic hypertension to keep their dietary sodium intake low, either by reducing or substituting sodium salt before pregnancy. Timely areas for developing research Large, worldwide, randomized trials should be conducted to see the outcomes for hypertensive women who take antioxidants/physical activity before pregnancy.
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